Who’s The Boss?

Question:  I work for $%^& Chain Drugs and I disagree with a couple of their policies.  I think one may even be in violation of the law.  Am I protected from Board action and/or liability if I obey these policies?

Question: I just started work at a new job.  The PIC laid down the law on the first day on such things as when CS refills can be filled, assigning techs to specific duties (on my day to work), counseling, even what computer I am to use.  Do I have any say or is the PIC that much my boss?

I get questions about pharmacy hierarchy almost on a regular basis.  It seems that there are numerous interpretations of how this hierarchy is defined.

In the 1980s, early in my career, and before the advent of the PIC position, the Board of Pharmacy made it clear that the responsible party in the pharmacy at any time was the PHARMACIST ON DUTY AT THE TIME.

This remains the case today.  When you are the pharmacist on duty, you are the final arbiter of decisions.  The results of the shift or day are your reward but they are also your responsibility and liability.  What goes right is not attributable to CVS or Rite Aid but your time, effort, education and experience.  What goes wrong—well, watch how quickly your employer will throw you under the proverbial bus.

So, let’s answer the above questions.  No, following a policy your employer has in place that is in conflict with applicable law will not prevent the Board from punishing you for violating that law.  You have the license to practice, not your employer.  The license is subject to your performance and the means you employ in following the law.  You are the person the Board will hold responsible.  If a conflict exists between law and employer, the law wins.

The PIC issue shows up regularly.  The PIC is in “full and actual charge” of the pharmacy, NOT the pharmacist.  Though the Board has carved out exceptions (some of which I do not agree with), the PIC is not responsible for the acts of other licensed pharmacy personnel.  If you misfill a prescription, if you dispense a prescription with a dangerous sig, if you permit an impaired person to work in the pharmacy with you, the PIC is not the person held responsible—you are.

Thus, if the responsibility is yours, policies laid down by PIC, owner, employer, etc are all subject to your professional judgment.  Do what you think is best, not what a company or your “boss” thinks.  If you can, sit down with your PIC or employer and explain your issues; firmly state that you will protect your license as well as patient safety over business policy.  If you need another opinion, call a pharmacist you trust.  Call me.

Some are going to cringe at the idea of telling an employer that a policy will be ignored.  Usually, employers are not unhappy when they discover a policy may be in conflict with the law.  They will quickly revise the policy to a non-violative status.  If your employer does seek retribution for not following a policy, or for any expression of professional judgment, boards of pharmacy are generally quick to act to protect professional judgment.

What is the hierarchy in the pharmacy?  In the final analysis, YOU as the pharmacist are the hierarchy when you are on duty.  Act accordingly.

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