Whether it is being the last line of defense against possibly harmful drug interactions, catching the abuse of addictive opioids, or offering a range of health services directly to patients ranging from vaccines, hormone therapy, and tobacco cessation, the professional judgment of licensed pharmacists plays a critical role in ensuring public health. Yet, the Legislature has heard uncontradicted testimony that licensed pharmacists are left alone for indeterminate periods of time in the pharmacies housed in large retail businesses and are, simultaneously, required by such establishments to perform non pharmacist functions such as staffing cash registers. Such inadequate staffing needlessly impairs the professional judgment and ability of pharmacists to do their jobs and, hence, endangers the public health.
Pharmacist failures can be deadly. For example, in August 2013, the California State Board of Pharmacy revoked the licenses of both a pharmacy and its pharmacist because the pharmacist failed to comply with statutory responsibility requirements in the distribution of opioid drugs. Four patients allegedly died as a result of the pharmacist’s actions.
The California State Board of Pharmacy’s decision and order in that case identifies numerous “red flags” that pharmacists are legally obligated to watch for before filling an opioid prescription. These “red flags” all underscore the need for pharmacists to have the time to do their jobs properly and include checking for such details as:
- Irregularities on the face of the prescription itself.
- Nervous patient demeanor.
- The age or presentation of patient (e.g., youthful patients seeking chronic pain medications).
- Multiple patients all with the same address.
- Multiple prescriptions for the same patient for duplicate therapy.
- Prescriptions written for an unusually large quantity of drugs.
- Initial prescriptions written for strong opiates.
- Long distances traveled from the patient’s home to the prescriber’s office or to the pharmacy.
- Irregularities in the prescriber’s qualifications in relation to the type of medications prescribed.
- Prescriptions for medications with no logical connection to an illness or condition.
In 2013, the Governor likewise signed legislation that significantly expanded the scope of practice of pharmacists. Pharmacists are now, without a prescription from a physician, permitted to vaccinate their patients, aid them in the administration of self-administered hormonal contraception, and provide nicotine replacement products.
The California State Board of Pharmacy has by regulation promulgated extensive protocols governing each of these new duties. Just as a pharmacist’s obligation to catch “red flags” requires time, so, too, must a pharmacist have the time to provide these new services according to ethical and legal standards. For example, just one of the expanded duties, self-administered hormonal contraception, the California Code of Regulations requires a pharmacist to:
(1) Ask the patient to use and complete the self-screening tool.
(2) Review the self-screening answers and clarify responses if needed.
(3) Measure and record the patient’s seated blood pressure if combined hormonal contraceptives are requested or recommended.
(4) Before furnishing self-administered hormonal contraception, ensure that the patient is appropriately trained in administration of the requested or recommended contraceptive medication.
(5) When a self-administered hormonal contraceptive is furnished, provide the patient with appropriate counseling and information on the product furnished, including:
(C) Potential side effects.
Comparable, patient-centered duties are rightly imposed upon pharmacists for the administration of nicotine replacement products and vaccinations.
Enact a new section 4113.5 of the Business and Professions Code that does not allow a business to endanger public health and impair the work of a licensed healthcare professional by requiring a pharmacist to have help, even unlicensed, help on-hand for chores that do not require a pharmacist license:
4113.5. A pharmacy shall not require a pharmacist employee to engage in the practice of pharmacy unless the pharmacist is assisted at all times by either another employee of the pharmacy or, if the pharmacy is located within another establishment, an employee of the establishment within which the pharmacy is located. This section shall not be construed to permit an employee who is not licensed under this chapter to engage in any act for which a license is required under this chapter.
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Ed Howard, (916) 844-5646 ,firstname.lastname@example.org Jassy Grewal, (951) 252-4491, email@example.com