Sunday, January 25, 2009

Updated: I Am Fucking Tired, So The Quality Of This Post Will Suck. But I Feel Bad For Teasing You. My Personal Story Of Trying To Do The Rite Thing.

Because at work I like to keep things personal. 

I think most of us in the profession can agree that making an effort to not have our customers become addicted to benzodiazapines would be the Rite thing to do. Our duty as health care professionals even. I think we can all agree on that. 

At least I thought we could all agree on that. Evidently there is at least one exception. My Pharmacy District Manager, with whom I really don't have a personal relationship. I've never met him. He was of no Aid to me when I tried to do the Rite thing though. Benzodiazepines are high markup items, so maybe he's thinking the company needs the money. He could be right about that part.

Customer wanted a refill of temazepam that was filled 4 days ago for a 90 day's supply. While the other pharmacy was being contacted to confirm said 90 day supply was indeed picked up, the customer EXPLODES, and contacts the corporate office. She managed to find the Rite number to call without much Aid. 

It's taking awhile to confirm the 90 day prescription. It was dispensed from a big mail-order outfit. I don't have to tell you what it's like to navigate through an organization like that to even find a person, much less one whose head is not up their ass. 

I should say at this point I am asleep while all this is happening. I usually sleep until around 2 in the afternoon. 

I should also say at this point the Pharmacy District Manager ORDERED THE OTHER PHARMACIST TO FILL THE PRESCRIPTION. Ordered the other pharmacist to dispense a 30 day supply of a controlled, habit forming medication when there was reason to believe a 90 day supply may have been dispensed 4 days before. A Pharmacy District Manager ordered this, which makes me think he may not be the Rite man for the job. Or perhaps he needs some Aid in his position. 

The other pharmacist buckles. Don't blame her. She's here on an H-1 visa and if she's fired she's deported. She's also a good person and perhaps the best pharmacy manager I've ever worked for. 

In stumbles the Drugmonkey in a caffeine-deprived haze. The other pharmacist is upset and doesn't want to talk about it, then leaves. At this point, the refill Rx has been filled, just as the District Manager ordered, and is ready to be picked up. The staff fills me in on the situation. 

Step 1) Grab that refill off the shelf and make sure it ain't going nowhere. 

Step 2) Sharpen the Drugmonkey claws. 

I called the large mail-order operation and found someone with their head nowhere near their ass. There is a person working at a large mail-order operation whom if I ever meet in the real world, I will take out for dinner and as many drinks as they'd like. They were able to confirm delivery of the 90-day package and that it was signed for. As Kramer would say, Giddyup

Oh, and the two prescriptions were from two different doctors. 

I called the customer to tell her we would be unable to fill her 30 day refill request. You know what the customer said? The crazy customer who went ballistic only hours earlier? 

"I understand. Thank you for calling."

Do you know what my District Manager said when I told him this? After putting me on hold for half an hour? That we still didn't have the power to deny the customer an early refill. My conversation with the customer was far more rational than the conversation I had with my District Manager. That's the saddest part of this whole episode.   

The conversation with the District Manager quickly devolved into a semi-screaming match, at the end of which I reminded my District Manager there was a poster in every pharmacy in the state of California that spells out in clear terms the circumstances under which a pharmacist can refuse to fill a prescription. Preventing harm to the patient is one of them.

"Send me what this poster says in an e-mail" Said The District Manager who has sent out dozens of e-mails to every store he manages telling them the exact place to hang these posters. This was his way of blowing me off and ending the phone conversation. 

My first thought was that my District Manager was a rookie under pressure from above to kiss customer ass who had a decision to make and blew it. After this phone conversation however, I realized I was wrong. He is a smug, arrogant, cocky power hungry bastard who has turned this into a pissing contest for no other reason than the need to feel his dick is bigger. He also is not an unintelligent man, which concerns me. I'm used to District Managers being kinda dumb and overwhelmed. 

At any rate,  I spent Friday in a nasty flame war with my District Manager. If I get fired, maybe I'll publish some of what I wrote here. There's some good stuff in there. 

That's where it stands at the moment. A District Manager for a major pharmacy corporation maintains he has the power to order pharmacists to give out early refills of controlled medications. 

Again I ask you Dear Readers, who the fuck needs cable? There is drama all around. I'll keep you posted. 

Update 1/30- After almost a week, the District Manager decided to say he did not, in fact, order the other pharmacist to fill anything. The other pharmacist had documented in the patent's profile notes, however, that the DM did indeed order her to fill the early 30 day refill. Determined not to let him slip out of this, I sent an e-mail to the DM pointing this out, and thanking him for teaching us the importance of documentation. A meeting was held between myself, the other pharmacist, and the DM. The District Manager claims it was a case of miscommunication. The other pharmacist maintained she most certainly felt as if she was being ordered to fill this prescription. I made the District Manager look me in the eye and say he did not have to power to force a pharmacist to fill a prescription against his or her professional judgement. Outcome acceptable. Situation stable. For now. 

51 comments:

The little tech that does... said...

Hang in there DM, you did the right thing.

Anonymous said...

Seriously dude, there are much better places that could use a good pharmacists like you. Isn't there a Costco somewhere near you?

Anonymous said...

DM you were so right... am I not mistaken that the little prison cell they call a pharmacy doesn't open with out a little peice of paper with your name on it? It's your license!! Keep up the good work! I'm off to fight my own battles of the day!

Anonymous said...

i'm a RPh(with a precarious US status) and i admire you for what you did; especially managing to find a human being to talk to at a mail order pharm. now why do you bother with your d.m????? next time you talk to him, tell him is cell phone is breaking and you can't hear him.

kris said...

if there had been an adverse out come if you had dispersed that script, it would, of course, your ass being chewed because there are those posters to remind you. Mamagers are the mastes of situational ethics...all those reminders of your legal and ethical responsibilities till the customer yells loud enough and gets hold of some spineless wimp in upper mamagement. The bottom line is profit and repeat business. Period.

Gluckdrachen said...

My man, that is so typical that I don't know whether to feel comforted that all of my conceptions about our profession remain confirmed or to be once again frightened off my ass at the ineptitude and arrogance of 'customer service' at middle and upper management levels.

Many times I feel that our ability to control the dispensing of class II, III, IV, and V items is the last bastion of real authority we have. MTM, counseling...they don't exist, but we still have the keys to the safe. Within the past year, my former district manager tried to compel a pharmacist to fill a control early and give the 'customer' a gift card for his inconvenience.

I'm not naive, but even I'm starting to wonder why we perpetually have to fight or barter for everything even that we are supposed to do in our profession. 'Profession' is a hell of a word; it's supposed to denote an exclusivity of knowledge and the necessary level of autonomy and authority with which to use it. We're spread too thin in our duties and governed by grocers. Profession indeed. At least I still have the keys to the safe.

If you're ever around Savannah, Georgia, I'll buy you a drink or many.

Jo said...

You did good. Let that customer go to the ER with complaints of vague and unremitting anxiety (hah!).

Liberal said...

Ballsy to detail so much. I like it.

DKLA said...

DM,

If worse comes to worse, contact the CA Board of Pharmacy. I really hate bringing in third parties into this crap, but if they fire you just because you are doing your job then that is enough for a lawsuit.

If your district manager still has what he would call "balls" left after you dealt with him, then I would advise the douches at CorpoPharm HQ to fully castrate him.

Also call the two doctors who filled the BZD Rx's so that they know what is going on (and be wary of this particular patient).

Good luck! All of us in the profession are behind you!

Anonymous said...

You are definately right.

I love that my regional manager is also a registered pharmacist so knows the rules and is goverened by the same laws and ethical guidelines as me. He knows my rights and his and know his ass would be on the line if he forced me to change my clinical decision by means of job threats.

RPh in the city with no pity said...

Glad you didn't cave. (We'll take you any day in my corpo pharmacy, where you will be trusted. In fact, all of America will trust you. HAAAA!) Love that I finally know where you work. It takes some pretty obvious clues for me to read between the lines. Anyhoo, thanks for sticking up for the "profession." When its my turn, I'll do the same.

The Angry Pharmacist said...

I'd tell him to contact the state board of pharmacy if he has a problem. CA state board (and the DEA) is pretty clear about the right to refuse to fill a narcotic Rx early.

Is this douche even a pharmacist? Has he ever worked in a store ever? Something tells me he's not.

Jessica said...

Wow. Go DrugMonkey. I bet this would make a great story for one of those "investigative" reporters on a local news network, should anything happen to your job.

Also, I hope your District Manager develops a raging case of crabs.

Allison said...

Thank you for reminding me that I made the Rite choice in not lending my Aid to a certain retail chain after graduating.

Your blog lends much needed humor to my otherwise monotonous days as a hospital rph. A thousand thanks!

Heather said...

Wow, Drug Monkey. You must be piiiiiiiiiissed if you're being that blatant (and honest) about your employer.

I'm a tad confused, though. I (legitimately and extremely sparingly) take a benzo for anxiety and mania. It's cheap as dirt. So are you talking about brand? And who the hell buys brand?

Anonymous said...

Drugmonkey - as a shrink, I'll tell you, you're my hero. (OK, first, I'd never prescribe NINETY DAYS of temazepam, but that's not the point.) Let the docs know, if you get the chance - if I heard about this, and the crap you got from your DM, I'd defend you with flaming swords of righteousness. Send a snottygram to the DM, and cc a request for clarification from your Friendly Neighborhood DEA Agent re: any ambiguity in this situation. (OK, you know and I know and everyone else knows there's no ambiguity, but the District Manager doesn't get it...)
Perhaps y'all can go out for cherry Cokes with Agent Friendly and do some role playing and the DM can learn what the phrase "don't make a federal case out of it" means.

Anonymous said...

Great Job Drug Monkey. I once had a DM order my partner to give out a yearly printout to a spouse - even after we just took their training cd-rom that said we couldn't do that. I can't name the company, but I'll give you the initials - CVS.

Anonymous said...

Keep fighting the good fight!! We are the drug police, even if there are those among us who are corrupt. You know what is right and what makes sense. Fuck that guy

Anonymous said...

Great job DM! There's no way you'll lose your job, everyone knows an RPH is more valuable than a supervisor in your company. They can hire another one of him in a second, how long will it take to replace you? A local Aid has a sign hung up "This location will be closed until further noticedue to staffing issues". And Seriously....what the hell are doing working for them??? I always thought you worked for CVS---guess I needed it spelled out for me!

Past couple of weeks I have had a field day reporting druggies to both doctors involved...and to my amazement in every case the doctor has ordered me to CANCEL the script! The joy of telling someone they've been snagged! Ironically in most cases it was their insurer who ratted them out to me, with that lovely DUR warning "other antianxiety agent other pharmacy other MD".

annpharm

Anonymous said...

Great Job man! I once thought I made the Rite choice in working for my former employer. But then I got Aid from another manager who pointed me to another chain. I can say that this place really hits the Target when it comes to backing up their pharmacists and allowing them to do the correct thing.

Don't put up with their crap, there is plenty of Aid out there to help you find the Rite job!

DB said...

After 20yrs in pharmacy, I've come to the conclusion that being a clueless prick is the #1 criteria for being a district manager...actually I came to that conclusion while an intern, but have had several interactions with such that has only solidified the fact.

Anonymous said...

I would of told that a##shole to fill it himself under his name so I could report him to the state board. I have heard some horror stories about Wrong Aid, but that one takes the cake. I would send emails to his bosses, the state board, and do my best to get that jerk fired.

Melissa

Anonymous said...

DM, you are the kind of pharmacist I want in my pharmacy.

Beloved Parrot said...

You done good, honey!

Anonymous said...

No wonder this company is the number THREE chain. And a distant third at that. Walgreens is laying off HALF their DM's and supervisors because they realized they were useless. How long before RAD does the same? Especially with all the red ink they're bleeding. How long before they are de-listed from the NYSE and become a worthless OTC penny stock? They are at $0.31 today. But hey, if they fire you they can always rely on more of that great contract pharmacist labor they use so much of right? They'll dispense anything. Jump off that sinking ship Drug Monkey. Good luck and keep doing the right thing.

Anonymous said...

You should go work for an independent. You wouldn't believe the difference. It's like a whole other profession. Just make a post about wanting another job, and I'm sure someone who reads this would hire you.

bulldog said...

I once worked for a small chain and my dm came in for a review. Said all was well but one problem brought to his attention was a complaint by a clerk at front register that I had failed to bring change quickly enough (we served as managers when real manager was gone). I was stunned and said I didn't recall anyone asking my opinion of said clerk. Then I told him no 16 yr old was going to evaluate me, find someone else and gave my notice right there. Now my own dm, own my own store, so now I get to jerk myself around for being lazy.

woolywoman said...

Go! Go! Go! and, uhm, is the dickwad a pharmacist? Because the state board would be the Rite thing to do. If not, there has to be some regulatory agency that is interested in his alleged drug habit.

Anonymous said...

Oh Master Of All Things Pharmacy

((((hugs))))

A whole mess of shit to keep some benzo fiend from ODing...

Where can I find a doctor to write up a 90 day supply of my benzo of choice.

DMs are turds. My brother works retail and swears all DMs are hatched from some central warehouse.

Sending you a case of Laphroiag...

LD 50 Rat

Anonymous said...

I always believed it was the Safe way to take the high road until my own supervisor bent to the pressure of a demanding bitch and gave her a gift card for transfering a prescription despite the fact she was on a govt plan.
$100,000 fine anyone?

Awal5587 said...

My bet is that the customer was pissed he/she would have to go a lonely night w/o their little helper when his/her package 'o pills hadn't come in the mail. But imagine their surprise when they got home and it was waiting for them! Suddenly it's not so important that the pharmacist couldn't legally fill their script.
Oh and I would've put money on you working at The Wal[greens]. Maybe it was out of hope that you dealt with the same corporate crap I have to. Although I'm finding out that the chain can remain nameless and it still be the same crap we all deal with!

DrugMonkey, Master of Pharmacy said...

Heather,

Yes, I am very pissed. I will be pissed until the little prick looks me in the eye and apologizes.

Let me clear up your confusion. The profit a pharmacy makes on a prescription is usually inversely proportional to how much it costs. The benzo you may be paying a few dollars for probably cost the pharmacy a few pennies wholesale, while it's not unusual for an insurance company to reimburse a dollar or two over cost for a $150 or $200 med. Given a choice between ten $10 prescriptions and one $100 one, from strictly a business standpoint, you would take the ten $10's every time.

To everyone else. Thanks for shoring up morale. This shit drained me for awhile, but it appears the DM is gonna take the chicken shit way out and not say anything after I bitch slapped him. The situation is stable for now, and hopefully I will be myself again soon.....

Anonymous said...

You should've had some balls, Drug Commie, and called the local Board of Pharmacy rep. You would notice how many DM's and the like would recoil when they hear from a sanctioning body. But then again, expect more of this type of interaction under the Obama bin Laden administration.

NeedleDancer said...

One more from the masses.
THANK YOU!!
Thank you for refusing to fill that scrip. Thank you for giving a shit about whether patients get addicted to their drugs, and doing what you can to prevent it. Thank you for reducing the likelihood that another 2 dozen pills will actually be re-sold to middle school kids, creating a profit for the alleged patient and addiction for kids not yet old enough to drive.
Thank you, for being an island of sanity and good sense in an insane world.
And thank you for helping us all see the humor in the atrocities.

DrugMonkey, Master of Pharmacy said...

Anonymous #16,

I did call the Board of Pharmacy. They were useless. Basically it went something like, "well....send us something in writing....and...um.....as soon as we can afford some stamps after California's budget crisis is over, we might mail something back to you."

In my first draft of this post, that part of the story was included, along with a big 'ol thank you for a generation of Republican administrations who have systematically destroyed our government institutions. Everyone thinks they hate big government, until a time comes when they need the help of a government agency. I will remind everyone here The California Board of Pharmacy is a government agency, and right now they are crippled to the point where they decided they can't even afford to send out a newsletter anymore.

I fail to see how the Obama administration.....that's right....I said the OBAMA ADMINISTRATION....:)))))) will continue the hamstringing of government to the point that made them of no use to me in this situation. I can certainly see how the Republican dicks in the legislature holding up the current state budget can though.

And don't think I didn't note the irony of someone saying I had no balls commenting anonymously....:)

Anonymous said...

You Rock even more that I'd thought! I love your response to anonymous...didn't understand the correlation, either.

I hope I'm as effective as you are as a pharmacist!!

Liberal said...

I think you have balls.

I'm amazed you got through to anyone at the CA BoP. I thought one always had to leave a message when trying to deal with them. Maybe they cut out the newsletter to pay someone to answer the phone?

Antisense said...

Oh... So that's the chain you work for. You have my every sympathy now.

Krystal said...

I find this funny, since I just got a job offer from Rite Aid (I've had my license since August and have been working elsewhere) because I would've ripped this guy a new a$#hole for pulling that.

jeff said...

As I tech at another chain who is currently going through pharmacy school you give me hope that there is some sanity out there

Beano said...

As a regular reader fresh from her facility's DEA inservice, I am pleased to inform you that not only were your actions in accordance with Federal law they made some mighty fine common sense as well.

Pharmacists DO have the right to refuse controlled substance prescriptions. The DEA is blowing you a big wet kiss right now.

Tell him to put that in his pipe and smoke it.

Mary said...

We have a pharmacist down on the corner who certainly did the Rite thing. He Aided us when my grandson was prescriped a medication, that in combination with another of his prescriptions, could have killed him. Wonderful guy.

I love my druggist. He works at the Rite Aid in Chico, CA on Vallombrosa. A very nice man.

jameed said...

It must have been stressful. You should have ordered a couple of Rxs for Xanax 2 mg (special order the round ones not the bar ones please) #90 with "PRN" refills from 2 different doctors.

DKLA said...

Damn! The guy pulled the "selective amnesia" trick!

Common occurrence with these douches, which is one of the reasons why documentation makes it so much sweeter.

Legally speaking, you got his nuts in wringer!

Pharmyard said...

Hi, I'm new to your site but from what little I've read I really like your style. The chain I work for briefly tried the non pharmacists as district managers thing a few years back...it was very brief and very much a disaster, for the same reasons you had trouble. I only have found myself in a situation once that a pharmacist dm told me to fill a script that legally shouldn't have been filled. I told him to come on down to the store and put his initials on it then because that was the only way it was going to be done. He dropped the issue at that point. Keep up the good work. You've got support from this corner of the world to add to the rest.

Anonymous said...

Dude I so feel your pain. Imagine being told how you cannot, under any circumstances, dispense a script for suboxone without an
X-DEA #. This was done via a blast fax from a higher up starting out "Ladies and Gentlemen...". Imagine how happy I was two weeks later when the Pharmacist's Letter (which the company provides to us free of charge) led off with something like "Find out why Dr.s are using suboxone for pain and they don't need the X-DEA to write for it"

Fucking idiot didn't even have the decency to apologize for their stupidity/ignorance

RainDrop said...

A colleague of mine was once "forced" to fill Viagra for a patient on Imdur. She had refused and the DM was irked by the customer complaint call. The DM himself went to the store and filled the Viagra using his own RPH initials. Then he left. Problem was, my colleague knew she'd be the one to OFFER COUNSELING when the Rx was eventually picked up (b/c DM wouldn't stick around) so she was in a very tough spot. I'm not sure what she did, but I knew she was extremely pissed off at the circumstances (she was the supervising RPh as well)

Your DM said there was a "miscommunication" - so what did he say was his original intention? To fill it or to not fill it? Even if there was a "miscommunication" it's either fill or refuse; there's no gray area.

Thanks for reminding me why I shouldn't ever return to retail pharmacy.

Stavros69 said...

I had my training (now they call it internship) at Bigelows Pharmacy in Greenwich Village NYC. It is the oldest pharmacy in the country. They never had a problem losing a sale for ethical reasons. The chains, however, do not let ethics interfere with a sale.

Jason said...

DM,

We once had a brief email conversation about SxSW tickets... if you ever come to Austin, it's on... Scotch is on me, too.

The Phrustrated Pharmacist said...

I know, I live in a cave, but I have just stumbled upon the wonderful world of blogs and blogging. And I must say it is a HUGE relief to know I am not alone. As in, I called the little men in the white coats and told them I might be able to make it out in the real world another day.

First, you absolutely did the right thing in this situation. I am sorry you were fired, and I would bet my ass that it DID have something to do with this incident, and the DM was just hanging out, waiting for the opening to pull the trigger.

As far as being fired, I would personally be jumping for joy - it's a sign from above, in my opinion. Why on earth would you want to stay in this situation? There are other places that are not like this, even in the chain world!

Please remember, too, that the state boards ARE NOT THERE FOR THE PHARMACIST!!! As a matter of fact, it is quite the opposite. I have found they cannot be relied upon to do ANYTHING for pharmacies or pharmacists. They were created to "protect the public" - from what, I am not sure. But they are clear about that, and steer clear from them if and when at all possible.

Oh, you do have some recourse. You cannot be fired for something that was expressed on a personal site. While I hate litigous people, especially when they yell discrimination, that is exactly the avenue I would pursue on this one.

Right now I have the best of both worlds - I run an small, independent pharmacy, yet have not had to risk my own money in ownership. Very rarely do I have to put up with "Upper Management" crap. I have a job that, in comparison, is like a working vacation. I usually can eat lunch uninterrupted, take a potty break whenever I want (although this late in life, I have SuperPharmacistBladder), and even have a recliner in the break room.

But there still is the public at large, and that hasn't changed much. Different job, same shit.

I don't know why, as a profession, we put up with the shit we do. They cannot run these stores without us, yet we are mice when it comes to doing the right thing. I always made/make it abundantly clear that I will follow the law to the letter, with no exceptions. Getting this out there, up front, has been instrumental in my being able to say that I have NEVER had to defend myself or my techs. Others where I've worked have, but I am crystal clear about my stance. And I have only ever been promoted. Thanks for having some balls! We all need to grow a pair!

I posted something relevant to many of your posts this morning on my blog -

Besides throwing in my two cents worth here, I am shamelessly promoting my blog, and ask that you give it a look and possibly link to it on your site:



The Phrustrated Pharmacist

Kat said...

I knew you worked for Rite Aid ever since you mentioned your store manager tried to dampen your integrity by showing you the answers to the HIPPA trash quiz. It's nice to know that it isn't just my region where I envy those who have nothing better to do all day than decide how the trash should be sorted that week. Best of luck, you did the right thing!