Sunday, December 23, 2007

The worst thing is having your professional judgment and decisions questioned and overturned by a non-pharmacist store manager

A little over a month ago, our store was running a coupon promotion. As with any coupon offer, Medicare and Medicaid patients were excluded.

Well... one woman with a long history of being a royal pain in the ass came in and complained that the coupon offer was discriminating against Medicaid patients like herself. I explained to her that it was a federal law and not simply a store policy. She would not hear it. She proceeded to lash out about not only the coupon, but also about how the entire pharmacy staff was "incompetent." She said that her doctor told her that she hates the pharmacy staff and refuses to call in prescriptions to our pharmacy. The doctor supposedly makes an exception for this one woman because it's convenient for her to use our pharmacy. She wanted my name, the pharmacy managers name, the store license number, and any other information she could get so that she could go complain to the state board of pharmacy about how we were treating her.

I called a manager over to the pharmacy counter to help deal with her outburst. This particular manager was a good guy, and he stood up for the pharmacy and staff while telling the woman that the law prevented her from getting the 20% off coupon.

The conflict did not end here though. Unsatisfied, the woman went and complained to the manager of the entire store. Acting under the retarded principle that the customer is always right, the store manager gave her a 20% coupon and apologized for whatever inconvenience she had.

In doing this, the store manager (who knows absolutely nothing about pharmacy) made us all look like assholes. He broke the law in order to please one bitch of a customer who, being on Medicaid, can't afford to do much business with the store anyway.

Why do we even have these laws if they get overturned at the slightest complaint? I brought this to the attention of my pharmacy manager, and he actually took the side of the store manager. His rationale was that it's better to just quell her complaints now before she takes the issue to the board of pharmacy.

I was not at all satisfied with this explanation, and I let him know it. I made a decision... actually it wasn't even a decision since I was simply following the law. When I have absolutely no support from my pharmacy manager and my store manager in backing up what I believe was the correct response to her coupon tirade, it makes it look like I'm the one that was wrong and the moron customer was right.

This wasn't the first issue we've had at our pharmacy where our initial by-the-book judgement was questioned. Almost a year ago, another customer with a long history of being an asshole came in on a Saturday looking for a refill on his insulin. He had no refills remaining, so the pharmacy manager (a different pharmacist than the current one) told him that we'd give his doctor a call for him on Monday morning. He wanted his insulin at that moment and would not wait until Monday. The pharmacy manager asked him if he had any insulin left, to which the customer replied that he had enough for several days. Therefore, since the customer was not in danger of running out of insulin, the pharmacy manager told him that he would have to wait until we got refill authorization from the doctor.

The man flipped out. He started calling the pharmacy manager (Tom) a "pompous asshole" He said that Tom was on an egotistical power-trip, and he threatened to contact the board of pharmacy unless he got his insulin at that moment. Tom simply looked at him and smiled and told him that he will wait until Monday.

After firing off a few more insults (to which Tom kept smiling and gave him some smartass remarks back) the man walked away. During the following week, we got a visit from someone from that Board of Pharmacy. He asked Tom for his side of the incident. Tom told him the entire truth, and amazingly, it actually exactly matched what the customer had told the board. Tom had every right to tell that man we could not fill his precription. However, the guy from the Board of Pharmacy basically told Tom that this customer was "a very demanding man," and in the future, we should pretty much do whatever he wants just to avoid some kind of incident.

That was the stance from the FUCKING STATE BOARD OF PHARMACY!!!! "Just give him whatever he wants." They basically said, "We don't want any problems, so go ahead and break the law so we don't have to deal with it." However, you know that if we dispensed that insulin to him without a prescription, and he somehow had some incident due to a change of dose or medication that we weren't aware of, the Board of Pharmacy would be the first ones to throw us under the bus for it.

How can we use our professional judgement if whenever a customer disagrees with it, they can simply go over our heads and get our decisions overturned? That's not right, and quite frankly, it's dangerous. Otherwise, why bother even having all these dispensing laws?

What made me think of this after all this time was reading the Angriest Pharmacist's post about how he threw out a customer who treated him like shit. It got me to thinking how I'd love to be able to do that with a few of our customers. I've been sworn at, insulted, and borderline humiliated by customers, but if I say the slightest thing back to them, they can run to the store manager and get ME in trouble.

I firmly believe that in order for a pharmacy to be run safely and effectively, it has to be treated as a separate entity from the store. The pharmacy manager should have the final say on any issue that involves the pharmacy. Furthermore, unless a pharmacist's decision is blatantly wrong or endangers the saftey of a patient in some way, the decision should not be overturned if a customer decides to climb the ladder of authority. We cannot practice our profession while worrying that every decision we make will be undermined or overruled by someone above us.


Anonymous said...

Many points to agree, One to disagree.

The woman should've been allowed a coupon for groceries (not drugs), if that was the individual grocery manager's decision. In this situation, the basis could NOT be for having 5 scripts filled, but as a general individual manager discount, 'I like you' since that is what that manager wanted to do and they have rights over decisions about grocery items, not drugs.

The 'groceries' side of the business does not involve the pharmacy, though it is assumed that groceries may be purchased at the pharmacy counter. Technically, the woman should be able to have a coupon for groceries--and, possibly the OTC drug items, as well, if they are not part of the pharmacy drug stock. (Whatever is in the the non-pharmacy manager's 'jurisdiction' if you will. Drug vs. grocery purchases would have to rung up separately.)

Pharmacists have heard so many warnings about Medicaid fraud, from the government, Pharmacy Boards, local legal entities, employers, etc. that it does well to ensure we don't lose our licenses over such a matter.

There is such a thing as a pharmacist serving time in jail. In the pharmacist's defense, I think in this particular situation if brought to court, we pharmacists should be able to invoke the rationale for Good Samaritan law even if the patient doesn't need CPR!

The pharmacist manager should be the manager of the pharmacy, and he should answer to no one except the State Board.
Pharmacists should have COMPLETE authority over pharmacy-related decisions.

A disturbing trend I've seen in several K-Marts and Walmarts is that the general store manager decides technician staffing for the pharmacy. I think that idea has gotta go! (Out the window.) There's a delicate balance of immense prescription volume (which may or may not attract customers to one-stop shopping), the number of licensed pharmacy technicians. The pharmacist manager should have authority to determine staffing like any ordinary pharmacy!

Now, the State Board's decision about insulin...the patient wasn't out of insulin, why did the Board have to step in? Well, yes, the patient complained. In some states, pharmacy law allows insulin purchases without a prescription of insulin and supplies. However, if Medicaid or Medicare requires a prescription, then the solution might have been that the patient should not be allowed to submit the drug claim to the government agencies and should pay cash for the medication. (We could even use a biblical taxation analogy here...)

If the customer doesn't consider themself a patient, and thinks that they can demand things and be rude about it, so be it. As far as I know, pharmacists have always had the 'right' to refuse filling prescriptions, and police assistance if there's a ruckus, It's bad for business if the pharmacist doesn't assess that the underlying issue is patient mental sickness due to effective use or lack of medication. I've seen some patients with various chronic illness that I feel as if I could excuse their behavior because there's a lack of BG control, worsening AD, etc. That argument about refusing to refill has been used successfully in other more apparent situations, such as Vicodin earlies, duplicate scripts from different doctors, scripts for loads of old-time antidepressants, etc. even the Plan B refusal in PA. Refusing to fill is a pharmacist jurisdiction matter, especially if another pharmacy is open and available. Pharmacist's licenses aren't just available to everyone and last I heard they don't come in Cracker Jack boxes.

We pharmacists have to work GOOD FAITH in with our decisions. Sometimes it doesn't work out, but there's a reason that we as pharmacists need to abide by law--it's our protection as well!

Pharmacy managerial decisions should not have to involve testosterone, nor lack thereof.

Cinnamon RPh

Pharmacy Mike said...

In this case, the insulin was Lantus, which cannot be purchased without a prescription. the pharmacy board had to step in because a complaint was filed. Any time a complaint is filed, no matter how stupid it might be, the board has to follow up on it.

I'm just concerned that the decision from the Board was that we should just give this guy whatever the hell he wants to avoid a potential "situation." You might think I'm kidding, but that's exactly what they told us. There's something wrong there.

I disagreed with the decision to give her the coupon because the basis of her complaint was that she should get one due to her prescriptions at the pharmacy. The store manager may have given her one under the pretense that it was for something other than pharmacy, but that's all it would have been... pretense.

As for staffing, our pharmacy's staff hours is set by our district manager who pretty much follows some sort of rubric handed down from corporate.

Anonymous said...

Is this the board of pharmacy of the least populated state in the Nation? Why, in Heaven's name, was a board representative so hot to trot about a Lantus insulin complaint that he/she had to personally appear at the store? How did they make time for such trivia? Shouldn't they be hunting down Sudafed outliers? Now, that's REALLY urgent!

Then, WTF is this about "anything he wants?" How about Sudafed?
Methadone? Vicodin? Xanax?

If the squeaky asshole gets the grease and rules over everybody, perhaps it is time for pharmacists to start storming their boards of pharmacy in their own defense and screaming bloody hell for the rape of our profession. Why not put all the controlled drugs out in the cough and cold aisle if that's the way the protectors of the public feel?

Anonymous said...

If these two douchebags would of came into my store, I would of booted them immediately. One of the privileges of working for an independent.

I would of gotten the state board inspectors name and ID number, and a written letter of permission saying that he has given you authorization to dispense insulin without the auth from a doctor. That way if they pinch you in the future he will get thrown under a bus, not you. Of course state board inspectors couldnt cut it in retail or any "regular job" (much like medicaid prior auth approvers).

BlueTech said...
This comment has been removed by a blog administrator.
Anonymous said...

work in a hospital. screw retail.

Jena, Intern said...

I am so tired of Medicaid and the trash it brings into my store. I swear I fill more Medicaid RX's than any other RX's. Then these losers bitch about their $1 co-pay while throwing down alcohol or junk food down and want to pay for that too. What kind of world is this?? People who seem to ride the free gravy train Medicaid system promote being lazy and not having a job. BTW, that Medicaid bitch should have never gotten that coupon. Fricken store managers......

Chris, Intern said...

I'm not at all suprised at the state board's comments. Seems like pharmacy in general is all about, "Don't make us look bad." I remember my first year of pharmacy school, and the lecture that makeing the pharmacy school look bad in any way was a vialation of the ethical rules of the school. Doesn't suprise me that the board feels the same way.

And to any store managers reading, the customer is always right, but the patient is almost always DEAD wrong!!!

MileMasterSarah said...

Jena, Intern said...
I am so tired of Medicaid and the trash it brings into my store. I swear I fill more Medicaid RX's than any other RX's. Then these losers bitch about their $1 co-pay while throwing down alcohol or junk food down and want to pay for that too. What kind of world is this?? People who seem to ride the free gravy train Medicaid system promote being lazy and not having a job. BTW, that Medicaid bitch should have never gotten that coupon. Fricken store managers......

Why the bitterness with Medicaid customers? There are many reasons that a person may be receiving Medicaid. Low income is one of those reasons, but another common reason for a person to have Medicaid is disability. Both of my children have disabilities, and both receive Medicaid. I hate to think that my pharmacist is judging me, or my chidren for that matter, based on their secondary coverage being Medicaid. In Minnesota, some families will pay several hundreds of dollars in parental fees to have their disabled child covered under Medicaid solely because commercial insurance just DOES NOT cover the things that Medicaid does. What kind of world is this? I mean really? What kind of world do we live in that we have lost all compassion?

The *Angriest* Pharmacist said...


Sorry. Your pharmacist is judging you. We fill scripts all day every day. We see everything.

I see the person coming in and throwing me a Medicaid card from two different states (how do you have legal residence in both - a person needing medicaid has two houses???). I see the person coming in tossing me a medicaid card and proceeding to go buy a ton of candy, sodas, and beer. I see the person tossing me a medicaid card through the drive through while driving an escalade (in my state, you cannot own a vehicle worth that much and qualify for medicaid. You can own one auto per home and it cannot be worth more than X amount. You're poor remember?)

I love that medicaid is there for my Grandmother. *I* cannot afford her medicine on my salary - I know she can't on a 500 check each month. I love that medicaid is there for the disabled, like your children, that cannot afford their healthcare or provide for themselves.

I *HATE* that medicaid is there for the people I listed above. I *HATE* that medicaid is there, but I am getting some dickhead shopping doctors and pharmacies for vicodin all over the metro area.

That's what our intern was talking about. I'm sure she'd never judge or hassel someone who actually needed and effectively utilized the program as a crutch when they are working their way up or are in a situation where they could never make it on their own -- like the disabled or elderly.

But, let it be known that the pharmacist sees and knows. It's part of the unwritten rules of our job. Look out for yourself and your license otherwise it will be gone cause you are filling Vicodin for a bunch of punks shopping cards...

Mellee said...

Better late then never right??
To the person who mentioned that medicaid brings in trash, or something to that sort. How dare you make a judgement call, based on the few who abuse medicaid. I am not trash!! My 6yo son is not trash!!!! Who the (insert 4 letter word beginning with a F) do you think you are. I really only read the beginning of your comment, by then, I knew your just another idiot. It's people like you that give the pharms and the hospitals bad names. I'll tell ya, alot of medicaid people are hard working honest people, who hold fulltime jobs, and need some assistance. I hope to God that your just another SNERT pretending to be in this field, and not a real pharmacist. If you are I feel sorry for your customers. (Shakes head, rolls eyes @@)

Anonymous said...

I know this is a year after the fact, almost.

We've had a few incidences and my pharmacy manager just looks at me sideways while the customer bitched out the store manager and would whisper to me "I'm the highest ranking manager in the store, she can bitch and complain all she wants. She's not getting it. Even corporate can't make me do it."

This manager has gone out of their way to foster a good relationship. This has come in handy for these situations. Store managers, asm's, and shift supervisors have all flat out told customers "I do not have that authority, I am sorry."

It's beautiful.