Pharmacist files whistleblower suit

[TranslationalRPh]

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A pharmacist is suing his former employer, Walgreens Boots Alliance Inc., alleging whistleblower retaliation, age discrimination and defamation after the company allegedly fired him when he wouldn’t fill a prescription for fentanyl patches for a customer who had been arrested on a drug trafficking charge.

 

[RxPreceptor]

So many questions....mainly who thinks cutting fentanyl patches is a wise idea?

Even if said fentanyl patch from the article was a matrix system:
"Most fentanyl patches are available as reservoir membrane–modulated systems. Product labeling clearly notes that these patches should never be cut or altered. A fentanyl transdermal matrix system patch is available from Mylan; however, labeling for this product specifically warns users not to divide, cut, or damage the patch before application. No formal studies have been done to determine the clinical effectiveness of cut fentanyl matrix patches.


No fentanyl transdermal patches should ever be cut to titrate doses. Instead, health care providers should provide patients with a new prescription for a reduced strength of the patch. Patients should be warned about the risks associated with cutting certain patches."

The danger with cutting medication patches

In a case recently reported to the Institute for Safe Medication Practices (ISMP), a physician instructed staff from a hospice health care agency to cut a 50 mcg/h fentanyl transdermal system patch in half and apply it to a patient to deliver a 25 mcg/h dose. Soon thereafter, a visiting nurse...

www.pharmacist.com

 

[Dred Pirate]

I hope what the rph did was right, and I hope he gets a big payday at the expense of wags

 

[beautifulrobot]

So many questions....mainly who thinks cutting fentanyl patches is a wise idea?

Even if said fentanyl patch from the article was a matrix system:
"Most fentanyl patches are available as reservoir membrane–modulated systems. Product labeling clearly notes that these patches should never be cut or altered. A fentanyl transdermal matrix system patch is available from Mylan; however, labeling for this product specifically warns users not to divide, cut, or damage the patch before application. No formal studies have been done to determine the clinical effectiveness of cut fentanyl matrix patches.


No fentanyl transdermal patches should ever be cut to titrate doses. Instead, health care providers should provide patients with a new prescription for a reduced strength of the patch. Patients should be warned about the risks associated with cutting certain patches."

The danger with cutting medication patches

In a case recently reported to the Institute for Safe Medication Practices (ISMP), a physician instructed staff from a hospice health care agency to cut a 50 mcg/h fentanyl transdermal system patch in half and apply it to a patient to deliver a 25 mcg/h dose. Soon thereafter, a visiting nurse...

www.pharmacist.com

I read two-thirds of a patch "left-over" to mean that the entire patch was removed daily rather than every 72 hours, not that the patches themselves were physically cut. But your point still stands.

 

[RxPreceptor]

Yes, yes lots of vagueness in the article how person was actually using said patches and the dose intended by MD.

 

[owlegrad]

I cannot wrap my head around a pharmacy supervisor not respecting a pharmacists autonomy in regards to declining to fill a C2 in this day and age. I mean Walgreens literally has the C2 good faith whatever checklist mentioned in the article. Part of me thinks there has to be more to the story than what is presented here.

I hope he wins and the amount of damages is punitive enough to give the company a wake up call.

 

[owlegrad]

I read two-thirds of a patch "left-over" to mean that the entire patch was removed daily rather than every 72 hours, not that the patches themselves were physically cut. But your point still stands.

This is how I read it as well.

Personally I’ve never seen a fentanyl patch prescription written to change daily but I have seen scripts written to change every 48 hours. I wonder how punitive the DEA would be over that.

 

[beautifulrobot]

This is how I read it as well.

Personally I’ve never seen a fentanyl patch prescription written to change daily but I have seen scripts written to change every 48 hours. I wonder how punitive the DEA would be over that.

Interesting. It's been a minute since I've handled any fentanyl patch prescriptions - do you know what's the logic behind changing every 48 hours versus supplementing with oral for breakthrough or increasing the patch dose if it seems to "wear off" towards the third day? Or do some providers just not trust that it lasts 72 hours?

 

[owlegrad]

Interesting. It's been a minute since I've handled any fentanyl patch prescriptions - do you know what's the logic behind changing every 48 hours versus supplementing with oral for breakthrough or increasing the patch dose if it seems to "wear off" towards the third day? Or do some providers just not trust that it lasts 72 hours?

Like all bad prescribing I don’t think there is any logic behind it at all. Whenever I have asked why the answer has always been some variation of “that’s what works for this patient”. Thankfully I don’t see it THAT much in LTC but it does come up every now and then.

 

[TranslationalRPh]

I'm biased but this is a really bad look for WAGS. If this story is accurate, I suspect that they will settle and demand he sign an NDA.

 

[BenJammin]

Wags sucks but this guy doesn't have a case.

 

[Corytrade]

So many questions....mainly who thinks cutting fentanyl patches is a wise idea?

Even if said fentanyl patch from the article was a matrix system:
"Most fentanyl patches are available as reservoir membrane–modulated systems. Product labeling clearly notes that these patches should never be cut or altered. A fentanyl transdermal matrix system patch is available from Mylan; however, labeling for this product specifically warns users not to divide, cut, or damage the patch before application. No formal studies have been done to determine the clinical effectiveness of cut fentanyl matrix patches.


No fentanyl transdermal patches should ever be cut to titrate doses. Instead, health care providers should provide patients with a new prescription for a reduced strength of the patch. Patients should be warned about the risks associated with cutting certain patches."

The danger with cutting medication patches

In a case recently reported to the Institute for Safe Medication Practices (ISMP), a physician instructed staff from a hospice health care agency to cut a 50 mcg/h fentanyl transdermal system patch in half and apply it to a patient to deliver a 25 mcg/h dose. Soon thereafter, a visiting nurse...

www.pharmacist.com

I have recommended cutting the Mylan version. It is the same as the lidocaine patch. If you fear cutting it, it can also be folded in half and tapped down with Tegaderm.

There is a study (patient reported uses of fentanyl) that talks about a lot of different ways it can be manipulated. On phone, don't have it on hand.

 

[MilknCheerios]

While there are 2 sides to every story, not dispensing fentanyl is the safer option for both pharmacist and pharmacy. There is already litigation against Walgreens having partook in the opioid epidemic and this is additional evidence that Walgreens will fill any Rx to make a buck. The article seems to suggest that the defendants were just looking for a reason to fire this pharmacist, and if true, he may be awarded compensated for that too.

On a side note, the doctor should also be held accountable.

 

[Sine Cura]

Hansen said the company’s initial position about firing Simms was that he had violated the company’s privacy policy by accessing the patient’s profile in order to determine the next date of distribution for the patches. Simms checked that date after seeing the report about the patient’s arrest.

“Subsequently, Walgreens has changed its explanation for Simms’ termination to allege that he was terminated, in part, for contacting the patient’s physician and Johnson & Johnson,” the attorney stated.

At the time Simms was terminated, he was 59 years old. He was replaced with a “substantially younger employee pharmacist,” Hansen said. “After Walgreens took control of the Rite Aid stores in Maine, it has systematically removed older employees and replaced them with younger employees.”

Fired over alleged HIPAA violations? Walgreens sup sounds like a dip****.

 

[deleted885753]

Walgreens is in complete dump, aren’t they? Their stock isn’t doing good. Their finiancials were terrible.

They missed the trick by not investing into PBMs like CVS did and now their future prospect looks very uncertain.

 

[PikminOC]

Fired over alleged HIPAA violations? Walgreens sup sounds like a dip****.

Why did the pharmacist notify Johnson and Johnson?
Is it an ethical violation to look up the patient on the pmp in between fills?
Much like in malpractice cases, you are only hearing one side of this.
We dont know if he'd been in trouble before or how much the patient complained and to who else too...