Pharmacy Ethics

Each day we are presented with an ethical dilemma. Do you take the proper route and remain true to yourself, or do you take the other route and hope for the best. In pharmacy, ethical decisions are usually quite routine as you have to look out for the patients best interests.

I have discovered in my pharmacy travels that in a chain there is always one store thats a little... lax on the rules. Sometimes this is a good things, other times not so much. Today I was at this store in our chain and I have become accustomed to looking the other way towards practices which I do not believe in. Today, though, there was a string of events which has led me to question this store's pharmacist. I am left wondering how to bring this up my superiors in a tasteful matter, but respectful of a person whom has worked for us for well over ten years. It is a dilemma I am not enjoying grappling with tonight.

This pharmacist never makes a hardcopy on phoned presciptions (i.e. when the doctor or nurse or usually the custodian calls in the prescription). Thus we have no long term record to verify the proper dosing. This pharmacist never signs of on anything but Schedule II drugs. This pharmacist, and his trained staff, will almost always fill a prescription even though we need to contact the doctor for more refills (which leads to us being burned several times a week). I have seen this pharmacist dispense controlled drugs even though we were waiting for the mailed Rx to arrive.

Today though was something new. A woman came to the drive thru window. She is a well-known customer by us. Few years ago she was caught getting her Hydrocodone filled at several other pharmacies in the area. This lead to her being locked, by Medicaid, to solely our store. She receives on a regular basis Hydrocodone 10/500 #100 which is supposed to be a 13 day supply. She always picks it up on day 10 or 11.

Today she came to the window and asked for that said prescription. We stated that it was out of refills, which it was, and had not heard back from the doctor. She replied that she had talked to him this morning and he said he would call it in right away. Then something occurred which I have never seen in the 7+ years I have been doing this. The pharmacist filled the prescription.

He gave 100 Hydrocodone 10's to a woman with a past history of abuse on her word. I was flabbergasted. I refused to bag this prescription, I refused to sign anything relating to that prescription. I do not want to have my name attached to anything relating to this prescription.

This store three years ago lost its controlled substance license from the state for nine months stemming from a semi-illegal internet pharmacy that the owner had started. The store was literally raided and all drugs and records confiscated. Since then the store has been under close scrutiny from the state and today's incident, as with some of the others, will most likely be discovered in time.

So tonight I am left with a decision. I have been staring at my cell for the last hour trying to decide if I should call my manager and schedule a meeting tomorrow. The hard thing is I truly do like the guy. He's a 30 year veteran of the pharmacy world, so he comes from a different era (thus the lax behavior). The last year he has become a bit more grouchy and demanding from how he once was. He is one of the hardest working and dedicated pharmacist in the company (He usually works something like 28 days, 11 hours each, straight with a 2 day break). And I am now left with a decision which will most likely lead to his termination.

I understand the ethics involved. I know what I have to do. Its still a really really shitty choice I have to make, and there will be a ton of fallout from this. I think its time to pick up that phone now...