Joblessness Crisis for New Pharmacy Grads

Just a day or so after I published my Blog on how telepharmacy will cause permanent loss of pharmacist jobs in Michigan, a friend made me aware of an important blog entitled “A Looming Joblessness Crisis for New Pharmacy Graduates and the Implications It Holds for the Academy” published by the American Journal of Pharmaceutical Education (AJPE) and available at medscape.com/viewarticle/811430.   It is worth reading in its entirety but essentially there was too big of an expansion of pharmacy colleges and they have created an over-supply of graduates. 

The size of the academy was relatively stable during the 1980s and 1990s.  In 2000, there were 80 colleges and schools of pharmacy in the United States.  Since then, 48 new programs have been established and 2 schools combined into 1 college, bringing the total to 127 accredited colleges and schools as of fall 2012—a 60% increase from 2000...Since 2001, 31 colleges and schools increased their number of PharmD graduates by more than 50%.

This happened with law schools and law school graduates suffered grievously.  Another interesting quote from the Medscape article is the following:

Regardless of the job market, those new graduates who are “fittest” will be able to find employment.  But the profession of pharmacy should not fall victim to viewing graduates as commodities who must fend for themselves in Darwinian fashion.  Some might opine that the profession would benefit from filtering out its less capable pharmacists, but faculty members and administrators must not become insensitive to the plight of each graduate amid a backdrop of broader institutional concerns.  (Emphasis added)

There is a cult of people and politicians that are regressing our country into a kind of dog-eat-dog zeitgeist where a small number of families profit enormously while the rest of us are getting closer and closer to an abyss. 

It took centuries of struggle for humans to learn to cooperate sufficiently to trade relatively peacefully and to minimize the frequency and severities of war.  Humans became more advanced and empathetic and learned that we are better off when we share resources enough to ensure that everyone has something.    

The rest of us now need to look beyond our everyday “busy schedules” and become more active in politics and our profession—if only to survive.  Do not sit at home assuming that the MPA, the Board of Pharmacy or anyone else will save you without your effort.  Right now, it’s down to you and what you do.

A good start would be stopping telepharmacy in Michigan.  Write letters to your local newspaper editors, rally your patients and colleagues, bombard your political representatives and stop letting the greedy take jobs away from us.  Remember, mail order pharmacy started small.  Don’t fall for the story about conveniencing a handful of patients to allow telepharmacy to get a foothold in Michigan.

            I am not against useful logical innovation in pharmacy practice but, I am against losing a large number of jobs just to increase profits for a handful of people and putting the public in danger.

Permanent Loss of Pharmacist Jobs in Michigan?

Right now SB 373 is on track to become law.  SB 373 would authorize a pilot project to permit telepharmacy in Michigan!  Telepharmacy would allow one pharmacist through the use of computer technology such as Skype to oversee other pharmacies and even the dispensing of meds through machines such as PYXIS and pharmacy vending machines.  If you are a Michigan pharmacist or a pharmacy student you should do everything in your power to prevent the passage of this bill or any similar law. 

At law school the professors would tell us about laws that start small and end up big by using this saying:  “Once the camel’s nose gets in under the tent, how do you keep the rest of the camel from walking in?”  Michigan is a densely populated state and we are not North Dakota, Alaska or the Outback of Australia.  While there are a relative handful of patients who may find it inconvenient to drive to a pharmacy, there are already pharmacies that deliver and there is mail-order pharmacy.  There are other ways to help patient access that don’t involve destroying the profession of pharmacy.

There is a classic Chinese essay translated into English and published as Thick Face, Black Heart.[1]  This essay was a treatise for aspiring Chinese politicians to learn how to ruthlessly obtain their own self-interest while appearing to be doing good for the public.  That is the highest art form of deceit.  I believe the real purpose of this telepharmacy is to eliminate from payroll the cost of paying pharmacists and even pharmacy techs.  Under contemporary American business practices there is a relentless quest for increased profitability despite the fact that economic growth has been stagnant or even declining.  Since the cost of the product (prescription drugs) is not going to decline (because PHARMA has the strongest lobby), the only way to decrease cost is to reduce payroll.  You can do that by cutting the pay of pharmacists and technicians or even better, eliminate their necessity.  With telepharmacy you can have one pharmacist remotely operate several dispensing sites all over a county. 

Smart, selfish, greedy businesses have public relations consultants to create rationalizations to deceive the public into thinking that their selfish covert plan is motivated by doing good for the public.

For example, if a hypothetical pharmacy, “Cheap Charlie’s” was to go to its local senator and tell him that it wants telepharmacy because it saves a fortune by eliminating pharmacists and technicians but is putting the public at risk, the senator will have a hard time selling that legislation to his colleagues.  However, if Cheap Charlie’s claims that there are some poor souls who are being inconvenienced by a long drive to go to his pharmacy and telepharmacy would allow him to put a PYXIS machine right near their house while they would still be able to talk to a pharmacist on Skype, then it sounds like he is doing something wonderful and compassionate for the public good. 

Should you use Thick Face, Black Heart strategy to oppose SB373?  No, just be honest and tell your politicians in no uncertain terms that you don’t want to lose your job as a pharmacist in Michigan and this bill will help to put more nails in the coffin of the once great State of Michigan.  If you knock half or more of the pharmacist jobs out of Michigan who is going to be left to pay taxes and buy products?  We have put anywhere from five to eight years of education into becoming a licensed, professional pharmacist and invested a fortune in education.  I for one won’t allow the Thick Face, Black Heart practitioners to steal that from me.  Remember protecting your own job and profession is morally acceptable, rational self-interest.  Greed is not acceptable.  Ayn Rand was a hack novelist, not a philosopher.  She is only revered by some because she makes sophomoric apologies for selfishness.  Rand’s savage economics only works in her fantasy novels, not in reality.

Think very carefully about what I have written and know that job losses happen much faster today.  And those job losses are permanent.  If you are one of the lucky few who doesn’t lose his job but gets to monitor multiple pharmacies by Skype, ask yourself if that is why you became a pharmacist?  But you may say, I own pharmacies and I would love to eliminate the expense of a pharmacist.  Well only a handful of pharmacies, the elite in-group, will get into the three-year pilot project.  Plus, you will lose market share to the insiders.  And, do we want Michigan to be a third-world state where paying off politicians is the ordinary way of doing business?  Further, if there is less demand for pharmacists, we won’t need three colleges of pharmacy will we?

Won’t the good people on the Board of Pharmacy save us?  Yes, they are good people but no, they don’t have the power to save you.  The Board of Pharmacy implements statutes from the legislative branch.  Therefore, if telepharmacy becomes law then the Board can oversee the details of telepharmacy.

What can you do right now?  Contact your legislators and the governor and explain to them exactly why they should not pass this bill and express your views to the Board of Pharmacy as well.  Additionally, the ultimate lesson for politicians is a recall.  If they pass this bill then pharmacists should choose the most vulnerable Republican and Democrat (if Democrats vote for this) and recall one from each party.  The stated reason for the recall will be that they voted for SB 373 (or any other designation for telepharmacy).

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[1] Thick Face, Black Heart by Chin-Ning Chu.  I highly recommend the book Thick Face, Black Heart if you want a real education on how to advance your own selfish interests while making people think you’re a hero.  It is a great book that everyone should read, if only to recognize when you are being played.

What is a Summary Suspension of a Health Professional’s License?

            This blog will give health professionals a practical understanding of the rightfully dreaded, summary suspension of a license.  A summary suspension is a procedure under the Administrative Protection Act (APA) where the Department of Licensing & Regulation (LARA) immediately suspends a health professional’s license without a hearing or the opportunity for the health professional to defend his or her license.

            What are some of the immediate consequences to a health professional if his or her license is summarily suspended?  The health professional is immediately precluded from practicing in their licensed profession and will be unable to continue in their employment.  If they are in private practice, the insurance companies will suspend participation and payments, and the public and colleagues will become aware of the suspension with the attendant loss of prestige, humiliation and uncertainty—not to mention having to answer questions on license renewal, insurance, and employment applications with a “yes” to questions about licensing actions or suspensions.  If the practitioner is suspended in Michigan and holds licenses in other states, due to pervasive computer technology, those states will also summarily suspend licenses in their own jurisdiction.

            Again the license is suspended before the licensee has an opportunity to correct or rebut allegations that are relied upon as grounds for suspension.  The opportunity for grave injustice is always there when action occurs before all facts are in. 

            Decades ago sometimes practitioners might be suspended or sanctioned in Michigan but just go to Florida and practice there.  That is no longer the case and has not been so for a very long time. 

Constitutional Safeguards

            Under Michigan’s APA according to Section 92:

If the agency finds that the public health, safety, or welfare requires emergency action and incorporates this finding in its order, summary suspension of a license may be ordered effective on the date specified in the order or on service of a certified copy of the order on the licensee, whichever is later and effective during the proceedings.  The proceedings shall be promptly commenced and determined.

Summary suspension under this Act is subject to constitutional due process considerations.  Under well-established constitutional law, a citizen does not have a right to a health profession license.  However, once a citizen has obtained a Michigan health professional license then the Constitution protects that license from arbitrary state actions.  Before LARA can suspend or revoke a license, a licensee is entitled to due process.  Due process derives from the “Due Process Clause” of the U.S. and Michigan Constitution.  Due process comes in many varieties including economic, substantive and procedural due process.  Black’s Law Dictionary defines “due process” as:

The conduct of legal proceedings according to established rules and principles for the protection and enforcement of private rights including notice and the right to a fair hearing before a tribunal with a power to decide the case. 

Ordinarily, once you have a physician, pharmacist, nurse’s license, etc., LARA must accord you substantive due process, including a right to a hearing before a tribunal, before your licensed can be sanctioned.  Details and technicalities of hearing rights and duties are contained in the Administrative Procedures Act—a collection of statutes.

There is one major exception called a “Summary Suspension” of a license.  In a nutshell, a health professional Board can immediately suspend a health professional’s license when there is an imminent danger to the public’s health, safety and welfare. 

Imminent danger means an immediate, real threat to the public safety.  Because there is a presumption that a licensee is entitled to substantive due process before sanctioning a license and because a suspension of a license is so damaging to the licensee, the Constitution abhors summary suspension.  Summary suspension should be narrowly construed and rarely done.

An example of facts justifying a summary suspension would be where a physician or a pharmacist is schizophrenic and suffering acutely from delusions such that the licensee is incapable of practicing his profession safely.  Another example would be where a pharmacy is dispensing adulterated or counterfeit medications. 

A summarily suspended licensee has a right to petition for the dissolution of the summary suspension and an expedited hearing.  Here, immediate and highly skilled intervention by an attorney is required.

 At the Hearing for Dissolution, the sole issue is whether there is an imminent threat to the public health, safety and welfare. 

Almost invariably, a Complaint alleging a violation of the statutes and rules governing the profession accompanies the Order of Summary Suspension.  Thus, even if the Order of Summary Suspension is dissolved at Hearing, there remain the issues of the primary Complaint.  However, the client is rightfully relieved when the Petition is successful because the licensee can practice their profession while the Complaint is winding its way through the administrative process.  Great skill is often needed to restore the summarily suspended licensee.  And sometimes the facts are such that the Order should continue.

An automatic emergency action that results in a Summary Suspension is set forth in MCL 333.16233(5) which provides:

If a licensee or registrant is convicted of a felony, or a misdemeanor punishable by imprisonment for a maximum term of two years, or a misdemeanor involving the illegal delivery, possession or use of a controlled substance, the department shall find that the public health, safety or welfare requires emergency action and, in accordance with Section 92 of the Administrative Procedures Act of 1969, shall summarily suspend the licensee’s license or the registrant’s registration. 

Read the above paragraph again carefully.  One would think that only a very serious misdemeanor would trigger a mandatory emergency action against a licensee.  Note, a misdemeanor most often carries a one-year term of imprisonment and a two-year term suggests serious criminal activity.  The little devil in the details is the conviction no matter how trivial of a misdemeanor involving a controlled substance.  Marijuana is a controlled substance.  This leads to unfortunate situations wherein what most people consider to be an insignificant drug possession or use, would lead to the dramatic result of a summary suspension.  Most health professionals would draw a large distinction between heroin and marijuana—particularly where the marijuana use is unrelated to the offender’s professional life.

An argument is made that the licensee has violated a criminal statute.  Marijuana is still illegal and is still a controlled substance and therefore license sanctions should follow.  One can still reach that objective without a summary suspension.  There is time for fact gathering and consideration of mitigating evidence.  A strong argument in favor of summary suspension regarding marijuana would be where the licensee practices while impaired by marijuana.  But the above argument is moot because the statute reads as it does.  If an exception is to be made, it is up to the legislature.

HPRP

I have been pretty busy lately with what appears to be a new, more aggressive, unreasonable HPRP Program.  A number of clients have come to me for help and protection from HPRP.   HPRP seems to be demanding extensions of existing contracts several months before they are due to expire.  The demands often are instigated by the slightest causation.  The worse part of it is, in my opinion HPRP is a very dictatorial, aggressive and unreasonable toward its own patients. 

What a lot of health professionals don’t know is that HPRP is a for-profit corporation and I would emphasize the for-profit aspect.  There seems to be some misinformation extant that HPRP services are provided free or that it is some sort of benevolent, charitable organization.  That’s far from the truth.  Participation in the HPRP program is quite expensive and demanding.  If the health professional is unable to pay for services they are deemed to be in breach of contract and they are then threatened that they will be turned over to the State and lose their license to practice.

The threat of taking away a professional’s license because they don’t have money to pay for services is a heavy and frightening hammer indeed.  When an organization has that kind of power, it is up to the State of Michigan, health professionals and lawyers to stand up to the organization to ensure that such power is not abused.  No truer words were spoken when it was said that “power corrupts and absolute power corrupts absolutely”.

Kickbacks

Another very active area in healthcare law is criminal and civil cases involving kickbacks.  With the announcement of scores of kickback indictments in the Eastern District Federal Courts in Michigan it appears there will be a shortage of qualified attorneys to represent them!  The wave of kickbacks in the Eastern District I predict is crested and the Federal authorities will transfer interest to the Western side of Michigan.   And the difference will be that instead of indicting pharmacies, pharmacists, doctors, physical therapists, home healthcare providers, etc. located in urban areas, the focus in the Western half of the state will be on rural providers.

If you are a healthcare provider and are involved in a kickback situation it might be in your interest to contact me rather than wait for the hammer to descend.  Things can be done to mitigate situations.

Additionally, if you are approached by healthcare providers offering disguised kickbacks, please call me.  There are some healthcare providers that might be licensed to be a physical therapist or own a home healthcare agency, etc. but in reality they are criminals who just happen to be operating in the healthcare field. 

Some of these criminals are extremely effective in persuading physician’s assistants, nurse practitioners and doctors that their payment for being a “consultant” or “board of director” in an ACO is not a kickback but a lawful way of getting around anti-kickback statutes.  Don’t think they are so clever, or worse delude yourself into believing that this seemingly free money is a loophole that this genius has been the only one to figure out.

The truth is, if this healthcare provider is kicking back money to you and claiming that this is payment for “mileage reimbursement” or for your purported work as a consultant or board of director, there will come a time when federal law enforcement will challenge you to prove that you put the hours in, did the work and drove the miles.  Don’t think the feds are foolish.  They have vast computer surveillance “data mining” and they are very sophisticated and have seen and heard about every bogus scheme that the local genius can come up with.

If you are running an honest healthcare practice, then you should be concerned about the criminals paying kickbacks.  How can you compete and keep your professional practice thriving when someone else is cheating by paying kickbacks to doctors or other prescribers, etc.?  You will lose income to the cheating criminal every time.  In fact, one tip-off that kickbacks are occurring is when you see a too rapid rise of a particular chain of pharmacies, radiologists, doctor groups, etc.

Who are some new healthcare providers that are in the federal cross hairs now?  Cardiologists doing unnecessary surgical interventions, psychotherapist, and physician’s assistants.  Physician’s assistants unfortunately are easy to rope in to disguised kickback schemes because they often don’t have an attorney who could steer them away from criminal schemes.

In conclusion, when you are approached by somebody claiming that they have a new loophole to avoid income taxes or to pay you for referring healthcare business to them, be realistic.  Give me a call and let’s talk about their proposal.  The odds are the bonus payment or scheme is likely just another disguised kickback that will ruin your life and practice.  You may prosper for a while but in the end a big hammer is coming and you will regret any involvement.

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.

What Nurses Make

"You're a nurse?? That's cool, I wanted to do that when I was a kid. What do you make?" "WHAT DO I MAKE??" I make holding your hand seem like the most important thing in the world when you're scared. I can make your child breathe when they stop. I can help your father survive a heart attack. I make myself get out of bed at 5am to make sure your mother has the medicine she needs to live. I work all day to save the lives of strangers. I make my family wait for dinner until I know your family member is taken care of. I make myself skip lunch so that I can make sure that everything I did for your husband today is charted. I make myself work weekends and holidays because people just don't get sick Monday thru Friday. Today, I might save your life. I MAKE A DIFFERENCE, what do you make?"