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USA Today has an interesting report on how pharmacy boards across many states have a majority of their board members made up of employees of major chain pharmacies, ensuring that any oversight of pharmacies or reduction of filling errors is limited at best.

The concept of having pharmacy chain employees on state pharmacy boards supposedly ensures that these boards have the expertise of seasoned professionals to draw from. While that may be true, it also ensures that the boards are staffed with a number of members who act to protect the interests of the pharmacies they work for. It reduces the concept of an "independent" state board regulating and overseeing the functioning of thousands of pharmacies in a state, to a farce.

For instance, in Illinois, the chairman of the Pharmacy Board has a day job as the national director of pharmacy affairs at Walgreen. Similarly, Pennsylvania's Board is chaired by the vice president of pharmacy services at Rite Aid. There are more such examples at Arkansas, Massachusetts and Minnesota where pharmacy chain employees occupy important positions on the board.

Nobody should be too surprised when these board members who have vested interests proceed to veto decisions that are detrimental to the interests of the chain they work for. A perfect example to illustrate the conflict of interest here is the case of Tonya Pearson, a pharmacist at a Jacksonville Walgreen outlet, whose failure to catch a prescription error led to the death of Terry Paul Smith, a construction worker. When the employee came up for disciplinary hearings, a board member who was also a pharmacist at Walgreen, vetoed a fine of $10,000 on the erring Pearson. She got away with a $1,000 fine, and an "education program" to help catch errors – something Walgreen should have put her through before it allowed her to fill prescriptions at their outlet.

Such conflict of interest has riled advocates of better separation between the regulator and the regulated. But, the status quo continues merrily, and the only sufferers are victims of prescription errors like Terry Paul Smith. It's injustices like these that inspire pharmacy misfill lawyers who often turn out to be the only line of defense against well connected, big name chain pharmacies and their widespread sphere of influence. 

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More than 2 years after her death, the parents of a two-year-old girl have succeeded in their personal crusade - the passing of an Ohio bill that would help reduce the kind of pharmacy errors that were responsible for her death.  Emily Jerry died in March of 2006 after a hospital pharmacy technician compounded a chemotherapy drug, with a saline solution that had up to 26 times more salt than was needed for the treatment.

Emily had been diagnosed with an abdominal tumor, and had had been undergoing chemotherapy at the Rainbow Babies and Children's Hospital in Cleveland. The cancer was almost gone, and her parents were looking forward to taking her home. A trip to Disneyland to celebrate the disappearance of the tumor had been planned, and all that was needed to say goodbye to the hospital was one last round of chemotherapy. Instead, Emily woke up after the treatment in severe pain and vomiting violently. She died three days later. It was later that the pharmacy technician's horrible pharmacy error came to light.  

The technician was not charged because there are no regulations for pharmacy technicians in Ohio. She faced no disciplinary action. In her statement, she maintained that she had voiced her doubts about the composition of the solution to the pharmacist on duty that night, and he had "shrugged it off."   Just before mixing the drug, the technician had apparently been surfing the Internet planning her wedding. The pharmacist, who was on duty at the time of the tragic mistake, has been indicted on charges of reckless homicide and involuntary manslaughter.  

Now, a bill that was inspired by Emily's tragic and utterly preventable death has been approved by the Ohio state legislature. Emily's Act will seek to establish stricter regulations for pharmacy technicians, who will now be required to have at least a high school diploma, pass a state pharmacy proficiency exam and undergo criminal testing before they can show up for work.

There are two tragedies here – Emily's death, and the fact that it took the loss of a 2-year-old's life to wake up to the fact that too many patients were being subjected to the dangers posed by untrained and uninformed pharmacy technicians.    For hospitals looking to cut their overheads, it makes cold financial sense to have a number of technicians who are responsible for checking dosages, and placing the medications into containers, because they can get by with paying them a lower wage. Senator Timothy Grendell, the bill's sponsor admitted that he had faced "resistance" from pharmacies over the proposed measure that would mean higher salaries for trained technicians who met the new standards. 

In New Jersey, we're currently facing the prospect of a law that would limit a pharmacist's liability in the event of a mistake, so it's great news to have much needed legislation pushing for better standards elsewhere in the country.   

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It's everyone's biggest nightmare – popping a couple of pills for an ordinary ailment, and discovering later in your hospital emergency room, that the problem could be traced to pharmacy error at your local store. Now, a troubling report by WCNC points to an incentive scheme at North Carolina's biggest chain pharmacy as the cause of a growing number of errors at the franchise.

The company in question is CVS, which has the highest number of stores – 285 of them - in the state out of all the nationwide chains. According to the report, the distinction with other chains doesn't quite end there. CVS also has the highest number of citations from  the North Carolina Pharmacy Board for prescription errors. In fact, the Board has repeatedly cited the chain for creating a work environment in which employees are likely to make mistakes.

Regular customers who get their prescriptions filled at CVS are noticing the difference in service, the report says. Staff members often seem to be in a hurry to rush through prescriptions. It's not simply a desire to squeeze more out of their workday that's behind this high speed work environment. As the report points out, the company has incentive systems in place that reward employees based on the volume of prescriptions they fill. In fact, CVS pharmacists routinely receive updates on the amount of extra cash they stand to make depending on how quickly they can fill bottles with pills.

The extent to which CVS has been able to continue this practice unchecked, is shocking. Consider these statistics – the Board of Pharmacy stipulates 150 as the number of prescriptions that can safely be filled by a pharmacist in a single day. At CVS, some former employees have gone on record to claim that on a busy day, it's not unusual for pharmacists to fill as many as 500 prescriptions.  

In one complaint of pharmacy error against CVS that was filed with the Board, a pregnant woman took home what she thought was anti-morning sickness medication from her local Salisbury CVS store.   Only, it turned out to be a drug that's prescribed for patients with spinal injuries. When the Board investigated the number of prescriptions that were filled on the day of the potentially tragic mistake – a common practice when pharmacy errors are reported – it was found that the pharmacist responsible had filled 513 prescriptions on that particular day.

CVS itself sees nothing wrong with the speed at which prescriptions are filled at its stores. According to a spokesperson, certain speed is necessary in "specific defined circumstances."   The blasé attitude at CVS towards the concerns of the Board and the public, as well as the company's focus on volume and profits at the cost of patient safety, is appalling. But it's far from an isolated case. The push for profits over safety is common to most of the major nationwide pharmacies. The kind of prescription errors that result when pharmacists are counting the dollars that will be chalked up on their incentive sheets, instead of focusing on the name of the medication they are filling out, should be a cause for worry, not only for pharmacy error lawyers, but also consumers.

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