Where to draw the line with pharmacy mgr/dir

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farm4real

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Hello

My question is about where to draw the line with pharmacy mgr/dir-s who make life hell and prevent a professional ethical performance of duties.

Lots of people have sh&@y bosses, and work is just that, work...but the conditions in pharmacy are sometimes questionable...

No, I am not a snowflake ou innocent or lazy or what ever trolling-b.s. will come from this post, but....

For me the line was when my mgr/dir asked me to dispense an expired oral solution...I am a foreign pharmacist and have never encountered this in my country. I know the Financial squeeze is on for many healthcare systems, and pharmacists are a dime a dozen, but there seems to be ethical lines that are increasingly being crossed in everyday practice ... am I wrong and unlucky with my organization? Or have others noticed this?

Would love to read insightful answers..

Thank you

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If you don't think it's right, don't do it. Let your manager do it. He can take the fall if anything happens. You can claim plausible deniability later.
 
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#2 You can also report him/her and face some retaliation of some sorts everytime you work with him/her. The choice is up to you.
 
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That's absurd...your store sounds like it might give me a panic attack simply by the amount of expired inventory just laying around.

Former PIC wanted me to complete a month old partial completion for a CII; I told him he could do it if he so pleased. Don't get pushed around, especially when you know something is illegal, misbranding, adulterated, unethical, etc.; it's your license/name.

Same PIC pissed off another RPh by asking him sort hard copy scripts off location (at home); that staff RPh asked to move to another store after that incidence.
 
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Dispensing a medication you know to be expired? No f'ing way. We had a video link posted here not long ago (I think it was from Arizona?) where a pharmacist did just that and suffered very severe consequences. I would take it a step further and suggest reporting him/her, either to an "anonymous" ethics line or to their supervisor. If your boss is the owner I suggest you start looking for a new job pronto and possibly report him/her to your BOP.

Just for fun, what kind of expired are we talking about here? The date on the manufacturer's bottle is in the past, it was reconstituted but not picked up and now it is past the BUD, or some other kind of expiration?
 
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I got this hot tip that if a medication expires, you can just put a label on it and it makes the expiration date a year later! Now I NEVER have to send back expired medications, hoo-ray!
 
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Not sure what company this is but why aren't you doing your outdates?

Also how do they know you even have it?

This whole situation makes no sense.
 
I was the one who posted the video. In AZ, knowingly dispensing an adulterated medication (FDA definition of adulterated which includes expired) is a statutory 5 year suspension for non-clinical effects and almost a certain revocation with clinical effects. It'd be completely unprofessional to dispense under those circumstances as that's one of the few absolute matters we are responsible for.

(Now, let's privately say that I'm fine personally with taking expired solid dosage forms up to a certain point, I'm a bad example myself with Vitamin I(buprofen) after a bad run (reminds me I need to replace that bottle on my shelf). However, I wouldn't dispense it.)

So, I'd take the "why don't you dispense it" approach, then quietly tell the patient that you didn't hear it from you, but you might want to look into the circumstances of the dispense. Setting your boss up for failure is usually the best policy.

By the way, that guy who is in the video, I'm sure that sort of thing is what happened. That particular pharmacist among other things was a openly known religious bigot to his staff, and normally, a hospital would cover this up. Let's say that there's more to the story, but being actively disliked is probably the kiss of death in a pharmacy setting. You're going to make mistakes. The difference between making those mistakes and having them being consequential has everything to do with your ability for service recovery and mitigation. The best policy though is to avoid known problems like this. I'd write off your boss at this point for being a treacherous jerk right now and start being overtly nice but not trusting a word he/she says. But for the mistakes that you do make in practice, customer service recovery should be your policy.

Here's where I draw the line in general:
Things that have objective prohibitions, collaborating evidence and are illegal should be reported.
Examples:
1. Stealing narcs from the Pyxis (records and camera)
2. Sexual or physical assault in the presence of witnesses
3. Your circumstance if you were stupid enough to dispense it under your login

Things that have objective prohibitions but not collaborating evidence should weigh the costs of collecting evidence versus threat reduction:
1. Suspicion of stealing
2. Sexual or physical assault in your boss's private office without a camera
3. Your circumstance with you unwilling to refuse it

This is where you use your head. In scenario 1, I'd only actively collect evidence if I needed a IMMEDIATE reason to fire this person or in response to someone else initiating an action (nurse supervisor is calling down saying that there are missing narcs periodically such that I have a pass on initiation). If I don't need it, I let addicts go on stealing because the inevitable happens anyway. The best advice I was ever given as a civil servant is that "Don't worry about your problem children. They will take care of themselves." In scenario 2, that's circumstantial and hard. It goes from the situation where someone literally ran out topless and screaming at the top of her lungs from the perv's office (US Attorney successfully prosecuted him), to me entering a meeting room in VACO and smelling semen (and quietly stood on my feet not sitting until I quietly remarked that the smell should be familiar and we need a rape kit here). In scenario 3, no hard evidence, but you know better, so you shouldn't trust him.

Always practice threat reduction and risk avoidance period. There's different philosophies around nailing someone, but I find that it's a nuanced matter unless the behavior is both blatantly obvious and public enough.
 
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Take a look at the article below. This kind of things happen more regularly than you think.

http://www.latimes.com/local/lanow/la-me-ln-ucla-pharmacy-20170915-story.html

For organization as big as UCLA and as well funded, it is horrifying to read this on the news.

Now, Chief of Rx has stepped down, pharmacy closed, PIC case pending, criminal charges possibly.

Pharmacists should make a stand again any type of unethical behaviors from their superiors. At the end of the day, your license worth more than your job or prison terms.

However, always be prepared to face with consequences. Thus, document everything, so if you are retaliated, you have wrongful dismissal case.

I also suspect that you are being asked because you are a foreign pharmacist as you indicated, perhaps ask your colleagues about their experiences.

Maybe there is also a discriminatory case as well.

Good luck!
 
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Take a look at the article below. This kind of things happen more regularly than you think.


UCLA pharmacy closed after state finds it sent out drugs with expired, potentially dangerous ingredients

For organization as big as UCLA and as well funded, it is horrifying to read this on the news.

Now, Chief of Rx has stepped down, pharmacy closed, PIC case pending, criminal charges possibly.

Pharmacists should make a stand again any type of unethical behaviors from their superiors. At the end of the day, your license worth more than your job or prison terms.

However, always be prepared to face with consequences. Thus, document everything, so if you are retaliated, you have wrongful dismissal case.

I also suspect that you are being asked because you are a foreign pharmacist as you indicated, perhaps ask your colleagues about their experiences.

Maybe there is also a discriminatory case as well.

Good luck!



Thank you everyone....

A) BUD...It was disposed of by another pharmacist, but was dug out of the to-be -destroyed container by this mgr/dir....no, I am not kidding....And by “dug out” I really mean dug out, where
he/ she (to be anonymous) literally dug through the container without gloves to find ”waste” he/she thought the pharmacy could use to save money....

B) Major hospital in a SE state

C) All on camera, with several witnesses, included other pharmacists

D) I quit a week later, since I figured that this would not be a one-off request, and Am suffering with unemployment since our job-opening situation is not great... thus I continually ask myself If I did the right thing by leaving...intellectually I know it is better than a BOP sanction

E) Maybe it partially was because I trained abroad, but I have no proof of that......but I do not doubt it...

F) Witnesses all scared for their jobs , and mgr/dir is well known

Since I have never encountered such a situation, I was and still am in shock....


Thanks for the feedback everyone...and let’s hope the representatives of our profession start working to protect the dignity of the profession...
 
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A) BUD...It was disposed of by another pharmacist, but was dug out of the to-be -destroyed container by this mgr/dir....no, I am not kidding....And by “dug out” I really mean dug out, where
he/ she (to be anonymous) literally dug through the container without gloves to find ”waste” he/she thought the pharmacy could use to save money....

Gross, I imagine everyone else averting their eyes or "going to the restroom" in this scenario.
 
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Thanks for filling in the details. FWIW I think you did the moral thing by refusing and quitting. You might still consider taking it a step further and report them to the BOP and/or company ethics dept.
 
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Thanks for filling in the details. FWIW I think you did the moral thing by refusing and quitting. You might still consider taking it a step further and report them to the BOP and/or company ethics dept.
Yeah, that PIC needs a reality check.

People who pull **** like that in order to save the company money are scary
 
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Yeah, that PIC needs a reality check.

People who pull **** like that in order to save the company money are scary

What is nuts to me is not only is that PIC risking their own license (which is nuts enough), they are also risking the pharmacy permit and the entire company is at risk for fines and lawsuits. The very small short term gain is totally beyond negated by the risk. It's nuts. No way the company would want them to do that.
 
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I got this hot tip that if a medication expires, you can just put a label on it and it makes the expiration date a year later! Now I NEVER have to send back expired medications, hoo-ray!

Ah, a rising pupil in training from Grand Master (Emporer?) Sosoo...I believe he/she has been training in isolation recently in order to perfect the art of bull **** (been rather quiet on these boards without the spin zone nonsense)
 
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What is nuts to me is not only is that PIC risking their own license (which is nuts enough), they are also risking the pharmacy permit and the entire company is at risk for fines and lawsuits. The very small short term gain is totally beyond negated by the risk. It's nuts. No way the company would want them to do that.

Alot of companies are more petty than you would think. Everybody wants to cut corners and save money, but no one wants to do the dirty work and take the fall. The solution is pretty simple, thats why you get a fall guy, maybe a new grad or a nice foreign pharmacist that you expect to be a clueless yes-man. When the state board comes aknocking the PIC of course has "no idea" this was happening or pulls a shaggy defense.

Its pretty wack, you always see these scandals in the news and the pr always has the same bs about "independent deviation from standard policy by an individual." And its scary to think about, because in this job market its going to be tough to say no if you need that paycheck.
 
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Draw the line when they want you to do something with your license you believe is wrong. Let them do it instead and have the liability. I heard of a store manager scream and force a pharmacist to fill a fentanyl patch RX in a opioid naive patient and would not allow her to consult the prescriber (patient wanted now). If it were me, I would have logged off the computer, stepped aside, and told the non-pharmacist manager that she can dispense it with her login and credentials. That solves that.
 
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Draw the line when they want you to do something with your license you believe is wrong. Let them do it instead and have the liability. I heard of a store manager scream and force a pharmacist to fill a fentanyl patch RX in a non-opioid naive patient and would not allow her to consult the prescriber (patient wanted now). If it were me, I would have logged off the computer, stepped aside, and told the non-pharmacist manager that she can dispense it with her login and credentials. That solves that.
I suppose you mean "opioid naive"

That's insane.

I wouldn't have filled it even with a call to the doctor.
 
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Draw the line when they want you to do something with your license you believe is wrong. Let them do it instead and have the liability. I heard of a store manager scream and force a pharmacist to fill a fentanyl patch RX in a non-opioid naive patient and would not allow her to consult the prescriber (patient wanted now). If it were me, I would have logged off the computer, stepped aside, and told the non-pharmacist manager that she can dispense it with her login and credentials. That solves that.

I had a pharmacist tell me the front store manager once “forced” her to reopen the pharmacy after closing to fill a prescription. I would have reminded him that the keys to the pharmacy are in his safe if he feels that strongly about it.

Well, I probably would have been a bit more diplomatic then that, but I never understood pharmacist who think they can be forced to do anything by a front end manager. Even in this market front end managers are a dime a dozen compared to pharmacists and it’s the pharmacists who are in charge of the pharmacy.
 
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Hello

My question is about where to draw the line with pharmacy mgr/dir-s who make life hell and prevent a professional ethical performance of duties.

Lots of people have sh&@y bosses, and work is just that, work...but the conditions in pharmacy are sometimes questionable...

No, I am not a snowflake ou innocent or lazy or what ever trolling-b.s. will come from this post, but....

For me the line was when my mgr/dir asked me to dispense an expired oral solution...I am a foreign pharmacist and have never encountered this in my country. I know the Financial squeeze is on for many healthcare systems, and pharmacists are a dime a dozen, but there seems to be ethical lines that are increasingly being crossed in everyday practice ... am I wrong and unlucky with my organization? Or have others noticed this?

Would love to read insightful answers..

Thank you

Next time, ask him to send you an email with such request. He will know that you mean business. Start documenting everything and of course, I'll belabor the same advice. Find another job if you can. We do not have that many choices these days but you shouldn't have to deal with that.
If it happens again, and there's another pharmacist there, call him/her over and ask your boss to repeat his/request in front of that pharmacist. If it's over the phone, tell him "alright, let me put you on speaker phone so that everyone can hear you"
You should still document the incident before the video tape gets erased (usually happens between 1 month and 3 months) and submit a complaint to the ethics line, your board of pharmacy and your chief compliance officer. Thing is they'll likely fire you, but you will have a case the second they do that.

Best of luck!
 
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