SACRAMENTO – Californians, like all Americans, go to pharmacists more than ever, but for more than a year the state’s regulators have not conducted the investigations needed to watch over the rapidly changing industry.
That changes this month, as state regulators resume the undercover inspections they dropped them more than a year ago. These surprise visits, common practice in almost every state, should highlight careless pharmacists, overworked technicians and confused patients, Board of Pharmacy officials said.
California must do more oversight, because more people go to pharmacists, said Frank Palumbo, director of the University of Maryland’s Center on Drugs and Public Policy. By 2004, Americans are expected to take 4 billion prescriptions, a 33 percent jump from current levels.
After an October incident, Gertrude Krull, an 88-year-old resident of Chico, needs no study to tell her the state must inspect more. In October, Krull sent her daughter to get her prescriptions authorized by a new doctor.
Krull took one pill, collapsed and was rushed to the emergency room. There, doctors determined she had taken Mysoline — a seizure medication — instead of her heart pills.
Her chain drug store explained the pharmacist was filling two prescriptions for a Gertrude and assumed they were for the same person, although different last names were on the order.
The great-grandmother spent seven hours in the hospital waiting for her body to expunge the drug.
“Nobody should have to go through that. I’m thankful there are no after effects,” said the white-haired woman, who spends her spare time sewing stuffed rabbits for loved ones.
“I’m afraid there is no safe place to go anymore.”
In recent years, the Board of Pharmacy, the state’s investigator of pharmacies, has had a tough time doing its job. The renewed inspections come as the board has been hammered by bad performance reviews. A recent state auditor’s report cited a backlog of investigated complaints that was seven years’ deep in some cases.
Investigators, the report said, had “gross inefficiencies” in resolving complaints about potentially dangerous pharmacies. It also accused the department of circumventing federal overtime laws.
Last year, the board stopped the surprise investigations because it couldn’t keep enough investigators, spokeswoman Virginia Herold said.
Investigators moved from surprise inspections to handle complaints, but low pay and the intense workload made it hard to keep and attract more investigators, Herold said.
At one point, the corps of 23 investigators was almost cut in half, Herold said. Now, the board officials hope to have a full staff to tackle the backlog of complaints and do the undercover investigations of every pharmacy at least once every three years.
That’s still less than what most states do. Many states inspect each year, while other visit every two years.
Regardless of the timing of the inspections, there’s a consensus on what remains behind the problems: Too few pharmacists handling more prescriptions.
To survive the managed-care shakedown of the 1990s, locally owned pharmacies took on more prescriptions, said Todd Dankmyer, spokesman for the National Community Pharmacists Association.
The same applies to chain store pharmacies, which often find it hard to enough help, said Maryland’s Palumbo.
Too often, patient consultations get dropped from the process, which is something investigators will look for when they start their visits. But, Palumbo said, “three years seems to be stretching it a bit. Within that period, you could have totally different personnel in a pharmacy and it obviously reduces the probability of seeing problems.”
Regulators hope to do more frequent visits after they tackle the complaint backlog, which was 1,500 deep when the auditor investigated last year. Pharmacies with a history of more complaints against them can expect more frequent visits, Herold said.
Even so, it’s hard to inspect without inspectors, particularly since experienced pharmacists can make much more in private industry. Some pharmacies lure beginners with $80,000-a-year salaries and signing bonuses, such as new sports cars.
Now, state investigators make an average of $70,000 a year, which the state hopes to increase.
“This is the board’s No. 1 priority now and it seems we have the political climate to make sure we’re able to do it,” Herold said.