OT: Pharmacists and Politics

[njac]

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[All4MyDaughter]

I've already gone over this. If you need to give someone an epipen, just give them a flu shot first. Then it's covered by protocol.

I don't think this would hold up in court.

 

[zelman]

I don't think this would hold up in court.

Why not? As long as they're conscious when you ask "Do you need an EPIPENflushot?" I don't see how it would be technically illegal.

 

[All4MyDaughter]

Why not? As long as they're conscious when you ask "Do you need an EPIPENflushot?" I don't see how it would be technically illegal.

Because the patient doesn't NEED a flu shot, and if you are giving it as a pre-textual reason to do something you aren't otherwise legally entitled to do, you could face liability.

 

[zelman]

Because the patient doesn't NEED a flu shot, and if you are giving it as a pre-textual reason to do something you aren't otherwise legally entitled to do, you could face liability.

Nobody NEEDS a flu shot. If they agree to it (like I said, must be conscious) then it's legal (in MA, anyway - Patient signatures are optional on immunization paperwork). It might not be the intent of the law or even an ethical practice, but it is legal unless you can find a law that says I can't follow immunization protocols for some reason.

 

[Sparda29]

It's a great career for psychopaths though... that lack of guilt really comes in handy.

How do you feel about control btw?

 

[anewmanx]

How do you feel about control btw?

That's an ambiguous statement. Could you clarify?

 

[Sparda29]

That's an ambiguous statement. Could you clarify?

What's your stance on it? Should an ordinary citizen with no criminal record, and no mental health issues be allowed to purchase a gun? If they are allowed to purchase a gun, should there be limits on the types of guns they can purchase?

My personal stance on it. If you have no criminal record or mental health issues, you should be able to buy any kind of gun.

 

[anewmanx]

What's your stance on it? Should an ordinary citizen with no criminal record, and no mental health issues be allowed to purchase a gun? If they are allowed to purchase a gun, should there be limits on the types of guns they can purchase?

My personal stance on it. If you have no criminal record or mental health issues, you should be able to buy any kind of gun.

The *limit* to control that I find acceptable is requiring appropriate training with said weaponry to avoid accidental discharge. Especially if someone were to purchase fully automatic weaponry (which we can do in most parts of the US, contrary to popular belief.) Requiring said training would provide the basis for gross negligence prosecution should someone give free access to an individual with mental health issues, a juvenile, etc... to said weaponry.

 

[Sparda29]

The *limit* to control that I find acceptable is requiring appropriate training with said weaponry to avoid accidental discharge. Especially if someone were to purchase fully automatic weaponry (which we can do in most parts of the US, contrary to popular belief.) Requiring said training would provide the basis for gross negligence prosecution should someone give free access to an individual with mental health issues, a juvenile, etc... to said weaponry.

And if they pass said training, would they be allowed to openly carry? IMO, open carry is a bigger deterrent to crime than concealed carry. I personally think I should be allowed to walk around NYC with an AK-47 slung around my shoulder, a USP45 on my chest holster, and a .44 magnum on my hip.

 

[anewmanx]

And if they pass said training, would they be allowed to openly carry? IMO, open carry is a bigger deterrent to crime than concealed carry. I personally think I should be allowed to walk around NYC with an AK-47 slung around my shoulder, a USP45 on my chest holster, and a .44 magnum on my hip.

I regularly open carried when I lived in an high crime area of Virginia. Deterred a guy from robbing a store on two occasions. Each time the guy had a gun imprint in his waistband and turned around and walked out when they saw me packing.

 

[zelman]

How do you feel about control btw?

Sparda, in case you didn't catch it, you forgot the word "gun" and that's why you were questioned about this.

 

[Sparda29]

Sparda, in case you didn't catch it, you forgot the word "gun" and that's why you were questioned about this.

Oh ****, lmao just saw that.

 

[All4MyDaughter]

Nobody NEEDS a flu shot. If they agree to it (like I said, must be conscious) then it's legal (in MA, anyway - Patient signatures are optional on immunization paperwork). It might not be the intent of the law or even an ethical practice, but it is legal unless you can find a law that says I can't follow immunization protocols for some reason.

I didn't say it was illegal, although I think it could potentially be. I think it's malpractice and unethical. I like my license. I'll just dial 911 if I think someone is experiencing anaphylaxis.

 

[zelman]

I didn't say it was illegal, although I think it could potentially be.

So, we agree: not illegal.

I think it's malpractice and unethical.

That's what I said here:

...It might not be the intent of the law or even an ethical practice...

I like my license. I'll just dial 911 if I think someone is experiencing anaphylaxis.

I dislike patients dying in my pharmacy. I'll prevent that when I can AND keep my licenses AND dial 911. You can feel free to settle for the last two.

 

[Sparda29]

Some more piggies killing people. Fast forward to 1:20.

 

[anewmanx]

Some more piggies killing people. Fast forward to 1:20.

I would have done the same if an erratically behaving person approached me after repeated warnings that deadly force was imminent. It takes less than 2 seconds to pull a knife from your waistband, and less then three seconds to slash someone's throat in close quarters. +1 to the cop for showing restraint in waiting until the person was that close. You never know if someone has a weapon until they show it. You have to assume the worst.

 

[WVUPharm2007]

Crazy dude with a knife is a reasonable excuse.

 

[Sparda29]

I would have done the same if an erratically behaving person approached me after repeated warnings that deadly force was imminent. It takes less than 2 seconds to pull a knife from your waistband, and less then three seconds to slash someone's throat in close quarters. +1 to the cop for showing restraint in waiting until the person was that close. You never know if someone has a weapon until they show it. You have to assume the worst.

Could have stopped after 1-2 non critical shots. Just aim for the feet, can't walk = no threat.

 

[anewmanx]

Could have stopped after 1-2 non critical shots. Just aim for the feet, can't walk = no threat.

Yet again, your lack of training showing. Some men have been shot 22+ times and KEPT GOING. It all depends on if they're on drugs or not. PCP is a hell of a drug. Men have been known, on pcp, to keep attacking until all the blood ran out of their body through the bullet wounds.

Bottom line, bullets don't always stop people unless they're dead. The problem is you NEVER know if a guy is on drugs, so you have to assume shooting his feet won't be enough. If you're wrong, it's your life that goes instead of his. He chose to put his on the line, you were forced into it as part of your job.

 

[Sparda29]

Yet again, your lack of training showing. Some men have been shot 22+ times and KEPT GOING. It all depends on if they're on drugs or not. PCP is a hell of a drug. Men have been known, on pcp, to keep attacking until all the blood ran out of their body through the bullet wounds.

Bottom line, bullets don't always stop people unless they're dead. The problem is you NEVER know if a guy is on drugs, so you have to assume shooting his feet won't be enough. If you're wrong, it's your life that goes instead of his. He chose to put his on the line, you were forced into it as part of your job.

You know, people can't really walk well after getting shot in the foot/leg. Bullet pretty much destroys the bone.

Plus the guy was yelling shoot me as if he wanted to commit suicide by cop. Shouldn't have obliged him.

 

[anewmanx]

You know, people can't really walk well after getting shot in the foot/leg. Bullet pretty much destroys the bone.

Plus the guy was yelling shoot me as if he wanted to commit suicide by cop. Shouldn't have obliged him.

Yet again, no, bullets rarely shatter the bones. Furthermore a guy on drugs will continue to walk on a shattered bone. I once knew a high inmate that broke his own humerus in order to escape a restraint and try to choke a correctional captain. He was still trying to use the flopping arm. A person high on drugs or in shock will feel no pain and walk on a damn stump. I've known special forces guys who strappe their own blown off leg to their pack after putting on a tourniquet and dragged themselves to a cliff side and repelled to safety. Adrenaline and/or drugs can make you unstoppable.

 

[BidingMyTime]

And if they pass said training, would they be allowed to openly carry? IMO, open carry is a bigger deterrent to crime than concealed carry. I personally think I should be allowed to walk around NYC with an AK-47 slung around my shoulder, a USP45 on my chest holster, and a .44 magnum on my hip.

I don't mind open carry as an option, but I personally think its a bad idea. Sure, it could ward off a criminal....or if one is dealing with a psychotic shooter, they now know who to take out first by identifying people who are open carry. Also, some people just get too freaked out by guns, almost to the point of phobia. I think one should avoid doing anything distracting in public, for the same reason we don't let people walk around naked or with unleased animals, and why PDA and loud talking on cell phones is a bad idea.

 

[BidingMyTime]

Could have stopped after 1-2 non critical shots. Just aim for the feet, can't walk = no threat.

What JAFX said, also, what you are proposing is that people try to hit a small target on a moving target. This is difficult for even the best of gun shooters to do, it makes much more sense to go for the largest areas, the torso. Remember the police officer (anyone) is only supposed to be shooting to protect themselves from imminent death/disability (or someone else), they are shooting at someone who is trying to kill them, not trying to get the attention of a jaywalker.

 

[BidingMyTime]

So, we agree: not illegal.
That's what I said here:
I dislike patients dying in my pharmacy. I'll prevent that when I can AND keep my licenses AND dial 911. You can feel free to settle for the last two.

The problem is, you are diagnosing anaphylaxis, which is outside of your scope of practice. With giving a flu shot, if a person's throat start swelling up 10 minutes later, it's is almost certainly anaphylaxis, this is why giving epinephrine under protocol is allowed in this instance. But with someone coming in off the street, you have no idea if they are having anaphylaxis or if the problem is something else, that is why it is best to call 911.

Edited to add: not to mention, you already have a person having a medical problem, and you want to give them a flu shot on top of that? Without knowing if they have any contraindications to the flu shot (what if they have an egg allergy, all of sudden you've made the problem worse.) And if they are still conscious enough to discuss all of this with you before you give the shot, well then there is no immediate risk of dying, so wait for 911.

 

[zelman]

The problem is, you are diagnosing anaphylaxis, which is outside of your scope of practice. With giving a flu shot, if a person's throat start swelling up 10 minutes later, it's is almost certainly anaphylaxis, this is why giving epinephrine under protocol is allowed in this instance. But with someone coming in off the street, you have no idea if they are having anaphylaxis or if the problem is something else, that is why it is best to call 911.

Edited to add: not to mention, you already have a person having a medical problem, and you want to give them a flu shot on top of that? Without knowing if they have any contraindications to the flu shot (what if they have an egg allergy, all of sudden you've made the problem worse.) And if they are still conscious enough to discuss all of this with you before you give the shot, well then there is no immediate risk of dying, so wait for 911.

The likelihood of someone coming into your pharmacy in the condition we're describing is extremely low (0-2 per pharmacist career I'm guessing). The frequency of adults with egg allergies are somewhere between 1 in 250 and 1 in 500 (according to foodallergy.org). The chance that someone will present this way AND be allergic to eggs AND if they are, NOT be having a reaction to eggs already seems like it would be lower than the chance you could save someone's life.

There was a study a number of years back looking at using a desensitization protocol for children with peanut allergies. The study was conducted in emergency rooms. It was terminated because a patient died. They died when they started having a reaction already in an emergency room. Your attitude that calling 911 at any pharmacy in the country at any time of day given that the person was ambulatory when they arrived is sufficient to save their life is flat out wrong. Every minute matters.

 

[All4MyDaughter]

The flu shot part is dumb and probably introduces MORE liability into the equation. If you want to play physician and diagnose and treat anaphylaxis, just do it. Own it. Take your chances with the BOP. Giving that pretextual flu shot doesn't protect you in any way.

 

[zelman]

The flu shot part is dumb and probably introduces MORE liability into the equation. If you want to play physician and diagnose and treat anaphylaxis, just do it. Own it. Take your chances with the BOP. Giving that pretextual flu shot doesn't protect you in any way.

If we agree that giving an epipen is illegal alone, and giving it after a vaccine is not, I do not see how you think the legal option fails to offer protection.

 

[anewmanx]

Here is what this very heavy and serious thread needs right now:

 

[All4MyDaughter]

Also if every minute matters, try telling a juryn

If we agree that giving an epipen is illegal alone, and giving it after a vaccine is not, I do not see how you think the legal option fails to offer protection.

Because you're not giving it for anaphylaxis caused by a flu shot. That's the only reason you can give it.

 

[zelman]

Also if every minute matters, try telling a juryn


Because you're not giving it for anaphylaxis caused by a flu shot. That's the only reason you can give it.

I don't believe my protocol indicates that. As I said, this is following the letter of the law, not the intent. And until you indicate a law that will be broken no jury will come into play.

 

[All4MyDaughter]

I don't believe my protocol indicates that. As I said, this is following the letter of the law, not the intent. And until you indicate a law that will be broken no jury will come into play.

I seriously doubt you have a protocol that allows you to give epi for any indication other than post-vaccination anaphylaxis.

And you're wrong about the jury - you could face civil liability if you do this and injure or kill someone. You might also be charged criminally because practicing medicine without a license is illegal in many jurisdictions. Or, if you injure/kill someone you could be charged with homicide or assault. Your employer will probably fire you and you could be sanctioned by the BOP.

 

[zelman]

I seriously doubt you have a protocol that allows you to give epi for any indication other than post-vaccination anaphylaxis.

And you're wrong about the jury - you could face civil liability if you do this and injure or kill someone. You might also be charged criminally because practicing medicine without a license is illegal in many jurisdictions. Or, if you injure/kill someone you could be charged with homicide or assault. Your employer will probably fire you and you could be sanctioned by the BOP.

So, suppose you gave a flu shot and tell the patient to wait around for 5 minutes to make sure they don't have a reaction and they proceeded to wait and eat a snickers bar. They then go into anaphylaxis after 4 minutes. Do you then suggest we do a series of blood tests to determine if they have a peanut allergy or an egg allergy?

Probably not. Being in anaphylaxis after a vaccine is covered by protocol. The protocol says you administer epinephrine. It doesn't require any proof that the vaccine was the cause.

 

[owlegrad]

http://www.theonion.com/articles/th...keting&utm_campaign=LinkPreview:Week1:Default

 

[BidingMyTime]

If we agree that giving an epipen is illegal alone, and giving it after a vaccine is not, I do not see how you think the legal option fails to offer protection.

Because giving someone a flu shot when they ARE SERIOUSLY ILL is most certainly against your protocol, a person in active anaphylaxis, or having the symptoms of that is NOT a candidate for a flu shot at that point in time. Giving a flu shot will most certainly open you up to more liability, and if the patient dies, you can bet their lawyer will argue that the flu shot "harmed" them (and try to prove that it didn't when you gave it against your own protocol.)

I agree with A4MD, if you want to play doctor, just give the epi. I honestly believe your liability would be less (although definitely still there), then if you gave a flu shot first and then the epi.


Edited to add: I think you would also have a hard time proving the flu shot was given with "informed consent", giving the severity of how sick the person, their lawyer would argue that obviously no person could given informed consent for an optional vaccine while undergoing a life-threatening anaphylaxis attack. I wouldn't be surprised if you could get an assault charge for giving a flu shot in that situation, at least with the epi pen you could make the argument that you were genuinely trying to help (although outside of your scope of practice.)

I like to think you are just trolling, but you know, there are probably people dumb enough who would think your strategy would work.

 

[deleted390966]

,

 

[Digsbe]

Just curious, but would giving an epipen to someone suffering from anaphylaxis be covered under Good Samaritan laws?

One thing to consider though is that even if your state BoP doesn't give you any problems over it your state board of medicine might because it likely would be considered practicing medicine without a license to do so. The flu-shot thing to give an epipen under protocol wouldn't fly. For one it's most likely not within your protocol to give someone in a state of medical emergency a flu-shot which would be a violation of the protocol and by medical judgement it would simply be a bad idea to do so. I highly doubt the argument of "I gave them a flu-shot to give the epipen" is going to fly because the flu-shot was given inappropriately in the first place.

 

[BidingMyTime]

Just curious, but would giving an epipen to someone suffering from anaphylaxis be covered under Good Samaritan laws?

This probably varies from state to state, but the consensus in this thread would that it would NOT be covered by a pharmacist.....possibly a random bystander who has their own epipen who gave it to a stranger would be covered, but a medical professional who practices above their scope of license (ie a pharmacist giving it) would NOT be covered, because the medical professional would know the limits of their scope of practice, where as an unmedically trained person wouldn't know, so if the unmedically trained person gave it trying to help out, they might be covered.

Which just leads me to a new thought, maybe Zelman could help his hypothetical patient and protect himself by "accidently" leaving an epipen where a random untrained customer could grab it and give it to the customer possibly suffering from anaphylasix?






just jk Zelman, don't really try that, I'm pretty sure you would still be liable.

 

[zelman]

just jk Zelman, don't really try that, I'm pretty sure you would still be liable.

Obviously I'm going to start leaving the trainer pens around first so the regulars can learn how to use them.

 

[All4MyDaughter]

Just curious, but would giving an epipen to someone suffering from anaphylaxis be covered under Good Samaritan laws?

One thing to consider though is that even if your state BoP doesn't give you any problems over it your state board of medicine might because it likely would be considered practicing medicine without a license to do so. The flu-shot thing to give an epipen under protocol wouldn't fly. For one it's most likely not within your protocol to give someone in a state of medical emergency a flu-shot which would be a violation of the protocol and by medical judgement it would simply be a bad idea to do so. I highly doubt the argument of "I gave them a flu-shot to give the epipen" is going to fly because the flu-shot was given inappropriately in the first place.

I think a pharmacist who helps a patient with a legally prescribed EpiPen is probably covered by Good Samaritan laws. A pharmacist who just takes one off the shelf and gives it to a random person would not be covered.

 

[zelman]

Just checked my immunization protocol. It does not indicate a person who is critically ill would be ineligible for a flu shot. But what's more interesting is that it doesn't mention immunizations anywhere in the section that authorizes my use of epinephrine except for the timing of dermal reactions. All other symptoms are listed without mentioning vaccination at all, so I'm all set to give epi to almost anyone I want.