Pharmacy’s Catch-22: Save a life - or save your livelihood?

July 10, 2016

When a snap decision is called for, “What is our corporate loss-prevention policy?” can compete in an employee’s brain with “What is the best thing for the patient?”

David StanleyI remember staring out the window of my pharmacy school on a sunny day longer ago than I care to admit, suffering from a full-scale attack of senioritits. Graduation was just around the corner, and the professor was doing her best to keep the roomful of restless future pharmacists engaged in something productive. I was tuning in and out of the conversation until I heard the professor say something like the following.

“Say a person was walking past your pharmacy counter and suddenly started having serious chest pain. They’d never been in your store before, so they’d have no prescriptions on file with you. Would you give them a nitroglycerin tablet?”

I ignored what I thought a silly question (of course you would!) and went back to my daydreaming, until I realized to my amazement that a lively discussion was going on, with many soon-to-be professional pharmacists asserting that it would be the best decision not to offer relief to a person in serious distress.

When I took my first pharmacist job I asked my boss, who was then serving on the Ohio Board of Pharmacy, about this, and he chuckled.

“No matter what you do,” he assured me, “if you can frame it as ‘It was what was best for the patient,’ then you’ll be fine.”

Sound, commonsense advice for professionals who uses their judgment and expertise to make decisions, I thought.

Best, yes - but for whom?

Fast forward a couple decades, and as it turns out, that classroom discussion wasn’t so hypothetical after all. Consider this:

Katherine O’Connor was having an asthma attack while walking home in New Jersey with her boyfriend. Luckily, there was a drug store right there. But she only had $20, and the inhaler cost $21. And the pharmacist  wouldn’t give it to her.

“I said, ‘Can you just give her the pump? She’s on the floor wheezing ... I didn’t know if an ambulance would get there on time. He said there was nothing he could do for me.”

The above came from a story reported by New York’s Fox5 TV that made its way around the internet a few years ago.

By the time I saw it, I wasn’t nearly so surprised as I was in the classroom that day long ago. It was an extreme case, but after 20 years spent working for chain drugstores, I can understand how the corporate environment could intimidate someone into making the wrong decision.

 

Zero tolerance

Don’t get me wrong. I’m sure that if you were to ask any of the corporate bigwigs directly, they would tell you not to leave an asthmatic wheezing on the floor of their store. But those same bigwigs are also constantly sending out memos that say you must do this and we have zero tolerance for that, while the company’s liability lawyers have done everything they can to come up with a policy for every situation, which employees violate at their peril.

So when a snap decision is called for, “What is our corporate loss-prevention policy?” can compete in an employee’s brain with “What is the best thing for the patient?”

This means we have too many pharmacists who want all the credit for being professional without ever taking the responsibility for making a decision, such as ones who won’t dispense syringes to a patient with insulin in their medication profile, or who tell a tourist with no refills on a blood pressure medication that they’re just out of luck over the weekend.

We’ve all worked with one of “those” pharmacists, and from what I’ve seen, correcting “those” pharmacists doesn’t seem to be a priority among the big chains.

Am I wrong?

I might be wrong. Maybe there are now state board regulators who would discipline a pharmacist for giving nitroglycerin to a heart attack victim. If so, I’m dying to hear from one.

But not so literally as the patient who might be affected.