Thread by @egabler

“I am a danger to the public.”

That’s what a pharmacist wrote to the Texas pharmacy board last year.

Over the past few months, I’ve learned it is a concern echoed in some of the biggest retail pharmacies across the country.

nytimes.com/2020/01/31/hea…

Maybe you’ve noticed things yourself - long lines or an especially hurried pharmacist when you’ve picked up a prescription.

Or even worse - mistakes with your medication.

The mistakes aren’t insignificant. A 17-year-old in Connecticut thought she was taking asthma meds - it was really blood pressure medication accidentally dispensed by CVS.

In Illinois, a Walgreens gave a guy ear drops - instead of eye drops. He landed in the ER.

In Florida, an 85-year-old died about two weeks after a pharmacy at a Publix supermarket gave her a powerful chemotherapy drug instead of the antidepressant her doctor had prescribed.

Pharmacists are increasingly worried about making mistakes.

I found that state pharmacy boards and associations in at least two dozen states have been hearing from distraught pharmacists who say cuts in staffing have made it tough for them to safely perform their jobs.

A good example is Wesley Hickman.

The day before he quit his job as a pharmacist at CVS in Dec. 2018, he worked a 13-hour shift with no breaks for lunch or dinner, he said.

As the only pharmacist on duty that day at the CVS in North Carolina, Dr. Hickman filled 552 prescriptions —that’s about 1 every minute and 25 seconds — while counseling patients, giving shots, making calls and staffing the drive-through, he said.

Partway through his shift the next day, Dr. Hickman called his manager and quit.

“I said, ‘I am not going to work in a situation that is unsafe.’ I shut the door and left.”

He now runs an independent pharmacy.

A lot of pharmacists feel like Dr. Hickman, but they can’t just quit their jobs.

And they worry about complaining, even to the state pharmacy board. That’s why many complaints coming into the boards are anonymous.

Part of the reason is that many states have representatives who work for big chains as members of their pharmacy boards.

Pharmacists told me they aren’t comfortable speaking up when it might get back to their employer.

In addition to filling prescriptions, pharmacists have to do a bunch of other things: Give shots, tend the drive-through, answer phones, work the register, counsel patients, call doctors and insurance companies. Corporate offices track it all.

Pharmacists say they will get in trouble - maybe even lose their jobs - if they don’t meet metrics laid out by their company.

And those metrics are tied to bonuses in some companies, including CVS and Walgreens.

Pharmacy staff is expected to call dozens of patients every day too. You’ve probably gotten one of the calls, asking about refills or if you’d like them to call your doctor.

The staff is assessed on the number of patients they reach, and the number who agree to their requests.

At CVS, I heard a supervisor ask an employee why the store didn’t hit its target of getting 60 percent of patients on the phone. “Your reach is 44 and you are supposed to be over 60. Why do you think that is?” he said. Employee: “I find that those phone calls are terrible.”

Pharmacists say that having to juggle so many things leads to mistakes.

But it’s hard to know how many occur because companies aren’t required to report errors in most states. A lot of times they settle with families, requiring a confidentiality agreement.

At CVS, a form for staff members to report errors asks whether the patient is a “media threat.” CVS said in a statement it wouldn’t provide details on what it called its “escalation process.”

The American Psychiatric Association is particularly concerned about CVS, which it says ignores doctors’ explicit instructions to dispense limited amounts of medication to mental health patients.

Patients may use the excess pills to attempt suicide, the association says.