Things we should all know about but probably don't about prescriptions

I originally wrote this article and posted it to YourHub back at the end of July. Today I got a letter in the mail in regards to the original complaint. I am posting the original article and updating it with the court action.

In early July, I was called to testify in court at a witness for the prosecution.
When I filed a concern more than a year ago, I figured it would just go into a file somewhere, maybe generate some concern, maybe some positive action taken. I never figured that a complaint would come to a court case.
The complaint was filed against a pharmacist, not normally something any of us would do, but in this situation, I felt something was wrong. I didn't know if any law was broken or not but knew that customer service was very bad. I had not known, at that time, that it was just more than bad customer service.
Actually, the case would never have come to court or board hearing, but the pharmacist in question, rather than accepting what was a letter of admonition, requested a hearing. In doing that, the pharmacist escalated the situation to an administrative court hearing. The pharmacist would probably have done better with the former, although, in the end, it didn't make any difference.
First off, I trust most pharmacists. Up until this incident, I had never been treated disrespectfully or given information that I knew was wrong. We all have to have trust in things that are important to us: that our doctor will give us the right information, that our pharmacist will fill our prescriptions properly, that even our car mechanic fixes our car so it doesn't fail on the highway. When that trust is broken, it affects all aspects of our lives and makes us review who we can trust. I still trust my doctor, I still trust my regular pharmacist and still trust my car mechanic. I don't, however, trust this pharmacist or that particular pharmacy.
It wasn't a pharmacy I typically used. I had used it once, but the service was so incredibly slow, that I took that prescription back to my regular pharmacy.
The medicine in question was Pseudovent 400, a formulation of immediate-release guaifenesin (400 mg.) and time-release pseudoephedrine (120 mg.). It was being used to treat a chronic sinus infection and over-the-counter drugs hadn't worked for me. About that same time, Mucinex (and the D and DM versions) were authorized by the Food and Drug Administration as over-the-counter drugs, but the Mucinex D version, which has the same active ingredients (guaifenesin and pseudoephedrine) but in different combinations (600 mg. and 60 mg.) and both ingredients are time-released, according to the manufacturer. Because of the release of Mucinex as an over-the-counter drug, many drug companies stopped manufacturing the prescription versions. So, in the middle of the treatment, I was left trying to find the last pharmacies to fill this.
My regular pharmacy had run out, but searched around to find another pharmacy in their chain to fill the prescription. They found one, but they couldn't supply a full prescription. They filled that, then searched around for another pharmacy with Pseudovent 400 (or the equivalent) and found the pharmacy attached to a chain department store, which filled the rest. When I needed more, I called for a renewal (phone message) on a Sunday afternoon.
I couldn't get to the store until Wednesday and then the line was exceptionally long (very slow service). Knowing from experience that that many people in line could take up to one hour, I chose to come back the next day, when I had more time. I was, however, running out of the medicine, but had enough to carry me through Thursday evening.
I came back the next day. The line was shorter, but the service was still slow. After about 15 minutes of waiting, I told the person at the counter that I was there to pick up a prescription and gave her my name. After not finding it, she asked, in a nasty tone, if I had called it in that day and I told her that I didn't. She then said that she needed to check something and turned and went into the area of the pharmacy that they fill the prescriptions. At no time did I realize this person was not a pharmacy technician (at my regular pharmacy, either the technicians, interns or pharmacists do check-out as well). She came back and told me that they didn't carry that drug any more and that Mucinex D was the same medication. Frustrated at that point in time, I asked to talk with someone in charge. After all, I knew that Mucinex D was not the same medication and they had had four days to call me to let me know. I could have, in that time, either located another pharmacy with the medication or talked with my doctor about alternatives. It was now significantly after 5 p.m., the time that my doctor's office closes.
She left and took a very long time coming back. Disgusted with the situation, I went to look for the store manager. When he arrived, he apologized for the situation, however, he said that the pharmacy didn't come until his authority, that I would have to talk with the pharmacist directly or I could contact the chain's headquarters. I thanked him and went back. This time I went to the consultation/drop off window and asked for the pharmacist. The pharmacist came, told me that yes, they were unable to get the medication but that Mucinex D was exactly the same medicine. I told the pharmacist that was not true and the pharmacist admitted that I was right. I left with no medication and angry at both the customer service and the fact that two people in the pharmacy tried to direct me to the wrong product.
I went through the home office, actually got someone eventually with the regional pharmacy. Later that evening, we got a call saying that another pharmacy at another store in that chain still had the medication and would fill my prescription. We got it that evening.
While I was waiting to hear something back, I checked out some things about licensing and pharmacies. I found that I should file a complaint, if for no other reason, that my situation would be filed and if there were more problems, there was a history.
Fast forward more than a year later. I got a call from the State Attorney's General Office. I was asked if I would be willing to testify about my situation. I had guessed that there were more problems and agreed. What I didn't know is that they were acting on my complaint.
The hearing was just the prosecution, the defense and a judge. I was the witness for the prosecution. The pharmacist was there to testify on their side of the situation. To say that the pharmacist was unprepared is an understatement. Rather than having a lawyer, the pharmacist brought a Wal-Mart marketing director.
I told my story, the pharmacist told theirs. Questions arose. Apparently the person who I thought was a pharmacy technician at the very least, was just a cashier. She had no legal right to advise patients. The pharmacist first said that this was just an isolated incident and the pharmacist was on their way to consult with me, which the pharmacist didn't. The pharmacist said they were 20 feet away from where I was, at a counter in another room, but could hear everything and swore that the cashier said, "the pharmacist said," to which the pharmacist said, "She always prefaces her statements with 'the pharmacist said' or 'the pharmacist told me to tell you.'" Both are illegal and indicated to the court that this was a standard procedure and not an isolated event. Additionally, the pharmacist first stated that Mucinex D and Pseudovent 400 were the same drug. When told to read the law, which the pharmacist should know, in order to be the same drug, they have to be the same formulation-one can be a generic, but the active ingredients must be chemically identical. The pharmacist then relented and said that Mucinex D and Pseudovent 400 were not the same drug.
The hearing was at the Department of Regulatory Agencies, The Colorado Pharmacy Board and is a matter of public record at this point in time. The case was PH 2008-0004, Colorado State Board of Pharmacy vs. Sarah B. Ramsey, R.Ph., license # 17547. She was (still is?) employed by Wal-Mart Pharmacy #3582, near the intersection of Palmer Park and Powers Boulevard. The results were that she violated Section 12-22-124(1) and 126(1)(i), C.R.S. with Improper Drug Substitution and 12-22-126(1)(l), C.R.S., Improper Delegation, by having a non-licensed person counsel a patient. The board had issued a letter of admonition orginally, which Ramsey contested, which is why this went to a hearing. The board upheld the letter, feeling that this was more a blunder in judgement than willful violation of the law. Additionally, she has no record of any former disciplinary action. Ramsey can contest this action during the next 45 days. I have no idea if she will or not, but I got the feeling that this was the lowest level of reprimand. I do hope a lesson was learned and that she won't make the same mistake again.
I don't know what will happen next. I have not been back to that pharmacy to see if she is still working there. My concern still is that things may not have changed at that pharmacy. That particular chain's pharmacy relies heavily on attracting business from low-income families or the elderly, pioneering the low-cost generic prescriptions. While that is positive, all people deserve quality care, no matter what their income level. Mine was not a life-threatening situation, but what if it had been? And what if I never questioned someone who I should be able to trust?

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