Monday, September 21, 2015

Shifting the Burden of Responsibility

Remember Mrs. Norco? She was back yesterday with yet another prescription for Ambien. Mrs. Norco has another little problem in her life. She's managed to get herself up to 2 and 1/2 tablets of Ambien every day. She takes two at bedtime and another 1/2 in the afternoon for a nap.

Oh, I know you're not supposed to do that, and she knows I won't fill her prescriptions for Ambien. She just comes when I'm not here and the other "popular" pharmacist fills her scrips without paying any attention to the instructions, quantity, or date. She's just a "customer" to him.

So yesterday Mrs. Norco hands me a prescription for Ambien, #30, take one at bedtime. Fairly straight forward, right? Except I know what Mrs. Norco is up to. She sees several doctors and gets these prescriptions and the dates overlap. The last time she had Ambien filled was fifteen days ago. Same doctor, same quantity.

"This is too early," I tell her.

"Oh, I know, but I gots the doctor approval for an early refill cuz she told me to take two at bedtime instead of one."

"Why isn't that on the prescription?"

"Cuz she says she can't write it that way. You can call her."

Mrs. Norco is trying to push her way through this one. Hasn't she learned yet that this game doesn't work with me? I tell her I'll call the doctor. Her eyes dilate slightly.

I call the doctor's office. Now for those of you in pharmacy, you know that I'm not actually going to get to talk to the doctor. It's very rare that we pharmacists actually talk to the doctors. They have a staff of people who have the specific job of keeping the doctor secluded from the outside world.

I get to talk to the doctor's assistant. I explain the situation. I explain that it is two weeks early. The assistant verifies that yes, the doctor told the patient to take two tablets at bedtime.

"Well, ok, then, I'll change the prescription to indicate that the doctor changed the sig to read 'Take two tablets at bedtime.'"

Long, long pause...

"Nooooo, the doctor wants it to say 'one at bedtime.'"

"But you just told me she's instructing the patient to take two tablets at bedtime."

Longer awkward pause...

I add, "What you're trying to do is shift the burden of responsibility onto the pharmacy if something goes wrong. If Mrs. Norco takes two at bedtime and then decides she wants a taco at Taco Bell and kills someone on the road, you want me to bear the burden of responsibility. I will not fill this prescription."

"You can't deny filling that prescription! I'll have the doctor call you herself!"


I gave the prescription back to Mrs. Norco. I explained the situation. She accepted defeat and slowly walked away.

As you can imagine, the doctor never called. I won that battle that day, but I'm losing the war. A few days later I looked on her computer profile. She saw a new doctor the next day and brought the prescription to the other pharmacist who filled it... # 60, two at bedtime.


Anonymous said...

And in the meantime, I have trouble getting my Levothyroxine filled a week early so I can go on vacation.

Anonymous said...

Isn't there anything you can do about this? If taking 20mg of Ambien is dangerous why isn't it being denied by all RPH's @ your store? If she takes the 20mg (written by the doctor) & she decides to go out for Taco Bell the filling staff member (& the pharmacy) would still be held liable because s/he knows that dose is too high/dangerous & still filled it?

I was a tech for 6 years in the 90's and busted a urologist for filling Ritalin for his wife. I know, what's the big deal once or twice in an emergency? When he wrote the script (on his yellow pad) standing in front of me @ the "drop off" window alarm bells went off. I checked her profile & he'd been writing the same script 1-2 times a month (200-400 tabs monthly) for a year. Why it was never caught, still escapes me (it was the first time I had seen the script & the RPH working w/ me)! Out of curiousity (okay, not true I was hoping for a big bust) I called every chain in my town & he'd been doing it everywhere for a year. That particular week alone he did it somewhere different each day paying cash each time.

The RPH (a close friend) said, "This ones yours! I'll support whatever you say/do!" I called the SOB back & told him we couldn't fill the script because it was out of his realm of expertise. He was ready w/ the excuse, "My wife has narcolepsy and her doc is out of town so this is just to get her by!" I handed him the print out & he knew he was busted. He asked for the script back & I told him I'd need to hold on to it as it would be turned over to the DEA. I thought he seem a bit nervous.

However, my cherry on top were the parting words I had for him after he turned away....."Oh & Dr. (insert his last name), good luck getting any other pharmacy to fill this one for you!" He didn't heed my warning because that night four scripts were collected. Each pharmacy went through their records and in total we collectively had approx 90 scripts (really embarrassing) & the case was turned over to the DEA.

Anonymous said...

You stood your ground because you didn't want to be the fall guy and you have a conscience to boot. Keep up the good work sir! I would also think that the corporate suits would have a big problem with one of their pharmacists aiding and abetting Mrs. Norco's scheme.