My Pharmacy Law CE

Here is the official flyer for a live CE lecture I will be teaching this January 9, 2013:

Community Pharmacies Allowed to Compete on Fair Ground

Wouldn’t you like this law in Michigan?  Pennsylvania has a new law that allows community pharmacies to match the terms and conditions that large PBM’s and mail order pharmacies use to lure customers away. This allows consumers the freedom of choice to use local community pharmacies or mail order and, of course allows community pharmacies to compete on a more level playing field.

January Pharmacy Law Seminar

Many of you have inquired about the Pharmacy Law CE class that I am teaching on January 8, 2013 at the Fisher Auditorium at St. John Providence Hospital, 16001 W. 9 Mile Road, Southfield, Michigan 48073.  The registration commences at 6:30 p.m. and the program commences at 7:00 p.m. and you will receive 1.0 C.E. hour. 

The sponsoring organizations, the Oakland County and Wayne Country Pharmacists Associations, are doing this at a nominal charge.  As I understand it if you are not a member of the MPA they request that you donate $10.00.  The fee is waived for students in a College of Pharmacy. 

You can contact Dale Tucker, RPh Med, BCPS Chair Program Committee OCPA dtucker@dmc.org  for pre-registration.

I am teaching this class to help pharmacists and I don’t receive any revenue from ticket sales.  However, I would appreciate a good turnout simply because I am putting a great deal of effort into this class and I would feel good if a lot of people attend.  I hope I see you there.

THE PENCAK REPORT

Christopher Pencak, Attorney and Pharmacist

27322 - 23 Mile Road, Suite 7 ▪ Chesterfield, MI 48051

586-598-4650

Website: pharmacylawpro.com ▪ Email: cpencak@pharmacylawpro.com

Fall 2012

Newsletter by E-mail

The Pencak Report is now available by e-mail.  Please forward your name & e-mail address to pencakreport@hotmail.com.

Communication

It’s been awhile since I’ve mailed out a Pencak Report, but it is time.  If you haven’t been to my website, www.pharmacylawpro.com you have probably been missing out on a lot of blogs.  I encourage you to visit the website because I am able to blog more frequently than mail the paper newsletter.  This Pencak Report is unique because it is dedicated to a central idea…communication.

It is no secret that the profession of pharmacy is rapidly changing.  Robots manipulate the physical dispensing of medication and pharmacists use monitors to remotely view prescriptions.  My personal research suggests that within a decade there will be a partial elimination of drugs themselves.  Yes, less tablets, capsules, injections, etc. 

Right now we use insulin for example, to augment a diabetic’s own endogenous secretions of insulin.  In other instances, we take psychotropic medications to chemically modulate neurotransmitters such as serotonin, etc.  The next step is to directly influence the brain and organs such as the heart or pancreas, by using direct electrical or radio wave stimulation.  I began to research this concept after a discussion with a client/pharmacist who had a Spinal Cord Stimulation System (SCS) implanted to electronically block pain messages from reaching his brain.  He was using opiates to relieve unremitting pain.  As you know opiate analgesics are believed to bind with specific receptors found mainly in the CNS.  He told me that the electronic interference was as effective to him as the opiates were.  The larger point is that pain is only one condition that is treatable electronically.  If you ponder the implications you will soon think of other organs and conditions that could be electronically stimulated or suppressed.  The CNS is a bioelectric system, yes?

If and when, electronics, stem cell manipulation and nanotechnology become common, what is the role of a pharmacist then?  Pharmacists will survive by what they do now that they don’t consciously realize.  Pharmacists communicate for a living.

This entire issue on communication has been inspired by my clients and other learned people I have come across by virtue of representing health professionals.  If you are not mentioned directly by name don’t take that as meaning you are not also a master communicator, it’s just that some of the names I will mention are more illustrative or appropriate for this particular newsletter. 

Community Pharmacy Level

When I think about pharmacists as excellent communicators to their patients and as a result are worth their weight in platinum to their employer, pharmacist Mark Kirsch comes to mind.  I have known a lot of pharmacists that are loved by their patients, but Mark Kirsch inspires such patient loyalty that they consistently travel with him to new employers.  Mark’s power is his genuine and sincere desire to help patients in an ethical fashion.  Helping a patient in an ethical manner does not mean simply saying “yes” to all requests from a patient.  Sometimes you have to say “no” to a patient’s request but the patient can still love and respect you.  The late comedian/actor George Burns once said something like “acting is about sincerity and when you can learn to fake that, you’ve got it made”.  Mark does not fake sincerity, he is sincere and all his patients love and trust him for it.

Authoritative Persuasion

As many of you know I have been very active and successful in helping all types of health professionals who have substance abuse or mental health issues to restore their license to practice or avoid criminal prosecution and other issues of that nature.  Generally, as a lawyer I will need a persuasive, credible and scientific report from a highly qualified addictionist or psychiatrist.  The readers of the reports are judges, administrative law judges, asst. atty. generals and other highly sophisticated legal professionals who have read thousands of reports in their careers.  My edge is that I only submit reports authored by extremely well credentialed, authentic, scientific experts.  Over the decades, one health professional comes to mind as the most persuasive communicator, and that is Dr. Bruce Baker, an addictionist with West Brook Recovery Center in Grand Rapids.

When I read reports from some experts or treating physicians the quality of the report is not persuasive.  Either the report lacks scientific rigor or the writer does not come off as genuine and authentic.  In contrast, Dr. Baker’s opinions are credible because they derive from rigorous scientific methodology communicated in a clear, unambiguous writing style.

Community Pharmacists Educating Society

Many pharmacists complain privately that American children are being overmedicated with potent psychotropic medications and the side effects frighten them and me.  I have spoken to community pharmacists everywhere and they tell me horror stories of kindergartners receiving extremely potent psychotropics because schoolteachers and some doctors find it much more lucrative and easy to urge parents to overmedicate their children with dangerous drugs than to take the time to understand and patiently correct a child’s behavior.  Here is where pharmacists should be speaking out publically as experts. 

One of my clients, pharmacist Frank Granett has spoken publically with his book “Over Medicating Our Youth” informing fellow pharmacists and childcare givers about the dangers of the drugs that are being forced upon children.  I would like to see more pharmacists speaking out publically about dangers and benefits of medications.  This is an opportunity for community and hospital pharmacists to communicate to society about subject matters they are expert in.  And the public benefits because the pharmacist is objective and knowledgeable.

Michigan Nurses Association (MNA)

Many of you know my wife is an R.N. and she keeps me updated on the Michigan Nurses Association (MNA) website and activities.  I am impressed with the MNA.  The MNA takes strong stands on behalf of nurses and their working conditions and it communicates to the public when politicians, hospitals and insurance companies endanger patients by conduct motivated by greed.  The MNA identifies Michigan politicians who act against the interests of patients and the nurses go door-to-door informing voters.

Health Professionals Educating the Public

“It’s easy to climb the ladder of success when

your father owns the ladder.”  Anonymous

Health professionals seldom contribute their expertise to the public arena.  Their absence from the media concedes the arena to charlatans who are paid to disinform the public.

For example, you might want to make yourself available to local and national television, radio, etc., to discuss whether or not Provigil® is safe and effective for “an executive seeking an edge at work.”  Yes, this is a white-collar version of the “performance-enhancing drugs” made infamous by Lance Armstrong.  I was shocked by a TV “news” story that even claimed there were “no side effects”!

And for example, if nurses and pharmacists do not educate citizens when sociopathic CEOs put lives at risk in the pursuit of bigger bonuses, who will?  In my opinion, all health professionals need to inform the public-at-large that for-profit health insurance companies are the problem and not the solution.  Not only do for-profit health insurers drive up the cost of health insurance because of the unnecessary, overpaid middlemen but additionally, they encourage waste, fraud and denial of necessary medical care.  If you cut provider reimbursement excessively, how will some try to survive?  The public will not hear this kind of opinion if health professionals don’t tell them. 

The public assumes you make three times the money as you actually do.  The public knows that you deserve to be well paid because you make a substantial contribution to bettering their lives; you add value to our society.

The public is now more aware that CEOs of private health insurers are vastly overpaid.  But the public is unaware that today’s doctors, pharmacists and nurses are vastly underpaid. I wonder whether it is time to let the public know the truth.

While one CEO of a health insurer gets a half billion dollars ($500,000,000) in a one year bonus for denying coverage, cutting pharmacy dispensing fees to nearly nothing and paying doctors too little money for a patient visit, the health professionals who actually heal the sick are seeing their own lifestyles and income erode severely.  I submit, I can find a person qualified to ruthlessly cut business expenses without remorse, much more easily than a person capable of transplanting a heart or kidney.  If you make the commitment to become a health professional you should enjoy the benefits in a just society.  Not so long ago, doctors and nurses rose through the ranks to become executives in hospitals.  They experienced caring for the sick and dying.  Today, you can start as a hospital executive without ever touching a patient.

Me Communicating With You

On one level, I make sense of the complexity of pharmacy regulation to my clients.  On another level, I communicate to prosecutors, judges and jurors what it is that pharmacists, doctors and nurses actually do for a living and how unclear the laws governing their practice are.  This year I have and will be doing a lot more communicating to groups of health professionals on the subject of pharmacy law.  I just taught a day-long seminar to health professionals who treat attorneys and judges with substance abuse problems.  (JLAP, sort of like HPRP)  This seminar was 75% pharmacology and 25% distinguishing between treating judges and lawyers vs. doctors and pharmacists.  Yes, I spent quality time with Goodman & Gilman’s.

On the evening of January 8, 2013, I will be doing a CE lecture entitled “Pharmacy Law for the Practicing Pharmacist” jointly sponsored by the Oakland and Wayne County Pharmacists Associations. It will take place at the Fisher Auditorium at St. John/Providence Hospital, 16001 W. 9 Mile Rd., Southfield, Michigan. I look forward to meeting some of you in person. I hope to do some lectures at our colleges of pharmacy in Michigan and elsewhere.

Pharmacists Communicating With Me

Please take the time to send me a succinct e-mail outlining your best practices for the detection of fake, forged or fraudulent prescriptions.  I will be adding the best of your knowledge to what I know so that my lectures and articles will be state of the art.   I know that some of you are going to astonish me with some of your ideas and I will likely be thinking to myself as I’m reading your email… “I wonder why I didn’t think of that?”  I can’t wait to read your ideas.

Books I Like

I have always loved books. Here are some on a variety of subjects. 

• Who Stole the American Dream by Michael Matthews.  The title says it all but you will be surprised how he traces the key events back to 1971. 
• The Price of Inequality by Joseph Stiglitz.  Current American history, economics and social implications of our extreme wealth disparity.  
• Empire of the Summer Moon by S.C. Gwynne.  Early American history should be mandatory reading for all high school students.
• Tracking and the Art of Seeing, 2^nd Ed by Paul Rezendes.  All North American mammals, their signs, tracks, habits—you will be surprised at what lives in even small suburban wood lots near you. 
• Bushcraft by Mors Kochanski.   This book teaches skills that once were common to our great-grandfathers/mothers but are lost today.  Things you can actually use such as how to properly sharpen knives, safely pruning or even felling trees in your own yard without killing yourself or damaging property or starting a fire with one match in a rainstorm, etc.  I used these skills recently when I spent a week in a tent in a remote region in far northern Saskatchewan.  If you go to a truly remote area do not trust that your outfitter is competent or that promised vital gear and food will be provided.  Expect that they will be incompetent and be prepared to do things for yourself.  
• Modern Streamers for Trophy Trout by Bob Linsenman.  Trophy trout in Michigan’s streams and rivers are primarily nocturnal feeders.  However, we fish most often during the daytime.  Where are those giant trout during the daytime?  Those trout are not where you assume a big trout would always be.

Practical Philosophy

I meet a lot of people who come into my office afraid, sleepless and unhappy because of their legal problems.  Those new or repeat clients frequently leave in a much better state of mind.  Many of the clients say that they “feel relieved”, “at peace” or “calmer” after meeting with me for legal counsel.  I often spend as much time on the client’s overall well-being as I do gathering information to address the technicalities of their legal problem.  If my client is facing a hearing or an important conference, they need to be able to sleep, be confident and healthy to maintain their professional practice, family and focus in order to present themselves as they truly are. 

A client who is fatigued from lack of sleep and worry may not be perceived as truthful and competent.  So with that in mind, I want to share some practical philosophy that I think you may find worthy of consideration.  If it is, perhaps you might suggest my blog to a colleague or friend for their thoughts.

Over the years I have seen repeated examples of my belief that the way you think about the world and yourself can have a huge effect on the reality of your day-to-day life as well as your future.

Just as you can make yourself ill through thoughts and beliefs, you can do the opposite.  How can you really change an ingrained belief?  By convincing yourself of a new possibility with indisputable facts that lead to an irrefutable fact.

Abraham Lincoln fought depression his entire life.  Abe Lincoln once said something to the effect of… “I’ve come to the conclusion that a person is about as happy as he makes his mind up to be.”

Dogma is defined as a viewpoint or system of ideas based upon insufficiently examined premises.  Eckhart Tolle wrote this about dogmas:

Dogmas—religious, political, scientific—arise out of the erroneous belief that thought can encapsulate reality or the truth.  Dogmas are collective conceptual prisons.  And the strange thing is that people love their prison cells because they give them a sense of security and a false sense of “I know.”

Nothing has inflicted more suffering on humanity than its dogmas.  It is true that every dogma crumbles sooner or later, because reality will eventually disclose its falseness; however, unless the basic delusion of it is seen for what it is, it will be replaced by others.

What is this basic delusion?  Identification with thought.

An excellent example of dogmatism making scientists look foolish was in the late 19th century where many physicists dogmatically believed that all that could be known about physics was encapsulated within Newtonian physics.  Of course, along came Einstein and Neils Bohr who shredded that Newtonian dogmatism.  In medicine it was the dogmatic view that stomach ulcers were a result of lifestyle.  An obscure doctor in Australia after years of dedication, proved to the world at large that H. pylori was a bacteria that caused gastric ulcers and such ulcers could be treated with antibiotics.

Today, I hear and read entirely too many dogmatic opinions and statements.  There is very little creativity and innovation.  In fact, some people vilify intellectuals and intellectualism as though that were a fault.  We need a lot more intellectualism and a lot less dogmatism.

A concluding but important tenet that is found in all sound philosophies and religions is that every person should be grateful for what they have and not obsess on things they do not have.  If you stop from time to time and take a mental inventory of what you do have and be truly grateful for it, you won’t fall prey to a negative outlook.

Teaching Pharmacy Law and Declining MPJE Pass Rates

The Wayne County Pharmacist Association (WCPA) presented a four-hour class plus lunch, to recent graduate pharmacists from all Michigan Colleges of Pharmacy and elsewhere, to prepare them to pass the MPJE—a test of relevant federal and Michigan pharmacy law. 

I taught that class on Saturday, June 2, 2012.  I am honored that the WCPA asked me.  Yes, I actually talked for at least three hours and the amount of information to be covered was such, that three hours of talking went by rapidly for me. 

Preparing to teach this course, I examined an April 16, 2012 table on the NABP website that covers the MPJE passing rates for first time candidates by Colleges of Pharmacy, from 2007 through 2011.  Ferris State, U of M and Wayne State University show a decline in the passing rate.   I have also noticed that practicing pharmacists, who have been out of the university for some period of time, could benefit greatly from more effective teaching on the subject of pharmacy law.

Obviously, if a pharmacist does not know what the law is, that pharmacist may unintentionally fail to comply with it.  Further, pharmacy law is not a stationary target but a moving one.  Laws change frequently and there are always new ones.  Articles on the internet and continuing education courses exacerbate the problem by confusing and frightening pharmacists with proposed laws and the author’s misunderstanding of the laws and cases that they purport to be qualified to opine on.  Journal articles are written poorly from a grammatical and clarity standpoint.  If you are going to paraphrase a law for students, make it understandable, certain and clear.  Poor writing skills leave readers bewildered and frustrated.  If you are unable to present a statute, regulation or common law (case law or “judge-made law”) clearly and simply, you are not an expert. 

Do not equate a photographic memory of rules and regulations to be the same as understanding and applying them.  It is unnecessary for a pharmacist to be able to recite from memory those provisions of the pharmacy law that he or she does not deal with on a frequent basis because that pharmacist can read those regulations when they become an issue.  You must however know they exist.  That is why pharmacies are required to keep current copies of the Statutes and Rules on the premises. 

Regarding the MPJE and the Decline in First Time Passing Rate

Based upon my interaction with the pharmacy students at the MPJE preparation, the pharmacy students of today are every bit as intelligent, motivated and capable as any who came before them.  I would rule out the students themselves as a factor in the decline. 

There are at least three other areas to examine in regard to the decrease in the pass/fail rate on the MPJE: 

1.      Can the method, procedure and content of pharmacy law classes at our colleges of pharmacy be improved?  All respect and deference must be given to our three excellent colleges of pharmacy, their deans, their professors, and in particular, their pharmacy law professors.  That said, virtually anything can be improved and I have a unique perspective by virtue of being a pharmacist and attorney who has decades of experience in the trenches in every venue where pharmacy and law intersect.  Many pharmacist clients have rightly acknowledged that there is a substantial difference between the practice of pharmacy and the collegiate perspective.  

There is a huge difference between being the trial attorney for a pharmacist in a criminal case involving allegations of diversion of narcotics through illegitimate prescriptions and, reading a synopsis of the results of that trial to a classroom.  Please note that this writer is in no way criticizing any professor but just pointing out some crucial distinctions.

2.     Is the present MPJE the best tool for assessing an applicant’s competence in the core areas of pharmacy law that practicing pharmacists require?  Have suppositions surrounding CAT and the questions been proven by disinterested experts?

3.     Are there simply too many laws and too much complexity in the vast world of pharmacy law?  Yes and the problems will only get worse.  I have some innovative ideas for efficiently learning, organizing and applying pharmacy laws.

Helping Practicing Pharmacists Learn the Law

The problem of effectively learning pharmacy law is not limited to students in the university.  Perhaps the greatest need is found in actively practicing pharmacists. 

The Board of Pharmacy currently requires one hour of CE units (of the 30) to be in the area of pain control.  That is a good thing but couldn’t there be at least one if not two hours devoted to pharmacy law continuing education?  I am a pharmacist and I do my continuing education.  Pharmacology and disease states are well covered and readily available in live and written CE’s.  In my opinion, the pharmacy law CE’s are poorly presented to practicing pharmacists.  I must state that it is painful for me to read some pharmacy law articles in journals, online, etc., the material is poorly written and raise more questions than the materials solve.  Sometimes the authors are quite simply wrong about the law.  The author relies upon secondary or even tertiary law sources instead of primary ones.  That means they are relying upon the person who did an abstract or synopsis of a statute or case law and if that person drew the wrong conclusions then the person scanning that abstract will be even more misinformed.

That brings us to an important question, who should present pharmacy law to pharmacists and pharmacy students?  What that should that person’s qualifications be? 

I attended a live continuing education seminar for my own pharmacy CE credit requirement that incorporated an MD from another state, whose practice is devoted to treatment of pain.  This physician opined from her research of law on the internet, that if a pharmacist calls on the telephone and verifies with a pain control specialist that the prescription was written for this patient and that is what the doctor intends, that the pharmacist is free to dispense those opioids without fear of further accountability to the Board of Pharmacy or the DEA.  If any of the practicing pharmacists in the audience followed that advice literally, it would not be very long before they would be calling me to defend them in an action by the DEA and Michigan Board of Pharmacy.  This physician was in my judgment learned and skilled in her profession but should reserve her opinion to her specialty.

After these experiences, I have been inspired to want to inject my perspective of pharmacy law into the university courses and continuing education for pharmacists – if the universities and practicing pharmacists want me.  A soldier who fights and thrives in deadly combat has valuable insights for soldiers headed to first-time combat that cannot be found in books. 

Conclusion

I am not saying that pharmacy law should only be taught by a person who is a pharmacist and an attorney.  It takes more than that to teach and inspire.  It takes expert knowledge and actual experience combined with excellent communication skills and respectful rapport with students.

Remember this...?

Some pharmacy computer systems check a prescriber’s DEA number. Do you remember how to do it by hand?

Ø  The DEA number always has nine characters: the first two are letters followed by seven numbers.

Ø  The first letter is always A, B, F, M or X. (F was added when all possible numbers starting with A or B were assigned.) DEA numbers starting with X are assigned to prescribers with a Drug Addiction Treatment Act (DATA) waiver. DEA numbers starting with M are assigned to mid-level practitioners.

Ø  The second letter is the first letter of the prescriber’s last name (unless the prescriber married and changed their last name).

Ø  Verify that a DEA number is authentic by:

a)     Adding the first, third and fifth digits together;

b)     Then add the second, fourth and sixth digits together and multiply this sum by 2;

c)      Add the results of a and b.

d)     The last digit on the right must match the last digit of the DEA number.