The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
The Ohio Board of Pharmacy on Tuesday imposed stiff sanctions on a CVS pharmacy in Canton over short staffing in 2021 that the board concluded had endangered patient safety. The penalties could be the first of many against the company because the pharmacy board is yet to adjudicate violations its inspectors have alleged against 14 other CVS stores.
The board fined the company $250,000.
As a condition of its minimum three-year probation, the store “must ensure that sufficient personnel are scheduled at all times in order to minimize fatigue, distraction, or other conditions which interfere with a pharmacist’s ability to practice with requisite judgment, skill, competence, and safety to the public. Staffing levels shall not be solely based on prescription volume but, in determining the need for staff, CVS #2063 shall consider any other requirements of the practice of pharmacy by pharmacy personnel during working hours.”
The pharmacy board also ordered the CVS store to come up with a system under which employees can request additional staff in writing and to share those requests with the board. It also prohibited CVS from retaliating against pharmacy employees who report dangerous situations.
Importantly, the ruling also requires the store to fill prescriptions within three days except those that are being automatically filled. Those have to be ready within five days.
Violating the conditions would be grounds for further penalties, “up to and including revocation of the pharmacy’s license,” board member Mindy Ferris said after listing the requirements.
Asked for comment, a spokeswoman for CVS noted improvements the company has made to the Canton pharmacy since inspectors found problems there.
“We’re aware of the Ohio Board of Pharmacy’s decision regarding our Fulton Drive NW pharmacy (in Canton) and will continue to work with the Board collaboratively,” the spokeswoman, Amy Thibault, said in an email. “The allegations stem from BOP inspections in 2021, during the height of the COVID-19 pandemic, and we’ve made great strides to improve the conditions there in the years since, including putting a strong pharmacy team in place that continues to provide high-quality care to patients. We’re committed to ensuring there are appropriate levels of staffing and resources at our pharmacies.”
The sanctions come at the end of a hearing process that began in November.
When an inspector from the pharmacy board went to the Canton store on Sept. 13, 2021, she found a staff that was so swamped they didn’t notice the inspector for 20 minutes. It was taking weeks to fill some prescriptions, and when an inspector made a follow-up call on Oct. 29, 2021, that person had to wait on hold for 20 minutes. Then that person was told “the pharmacy was over a month behind filling prescriptions,” the inspection report said.
To deal with massive staff turnover and other problems, the store closed its inside counter and told customers that they had to use the drive-through line to get their medicine. But even then, many were unable to get through the line before the store was forced to close at 9 p.m.
Haille Stanick, a former technician in the pharmacy, testified in a November hearing about being confronted in the parking lot by frustrated patients.
“I was cornered at my car by about three or four patients, all very angry, asking me what’s going on with their medications,” said Stanick, who explained that she understood their anger, but also that she felt threatened. “One gentleman was trying to get antibiotics for his son and he was very, very upset.”
In the pharmacy, inspectors also found phones that weren’t working properly, malfunctioning coolers, and a lack of controls over dangerous drugs.
During the hearings over findings at the Canton store, lawyers for CVS blamed the coronavirus pandemic for the problems found there. It increased the workload by requiring staff to administer vaccines and other care while also making many employees reluctant to come to work for fear of catching the disease.
However, the board, which is almost completely made up of pharmacists, didn’t seem to buy that argument.
“We hope that this decision will send a strong message to Ohio pharmacies that they have an obligation to serve their patients by ensuring appropriate staffing levels,” Steven W. Schierholt, the pharmacy board’s executive director, said in a statement. “The Board will continue to inspect and hold those accountable for working conditions that endanger patients and pharmacy staff.”
While CVS contended that the pandemic was to blame for problems in Canton, board inspectors found serious problems at other CVS stores in Ohio well before the worst had hit and as recently as last September.
At store No. 10246 in Toledo, for example, they made eight visits between March 2020 and June 2022. They found a pharmacy that was consistently dirty and disorganized, had expired or adulterated drugs on its shelves, saw lengthy delays filling scripts, created labels that didn’t have the proper instructions and at least one instance of giving a patient the wrong drug.
When interviewed, employees told inspectors, “supervisors/District Managers do not respond to staff calls for help,” the inspection report said.
The board will begin hearings on those violations in March.
CVS is part of a vertically integrated company that owns doctors’ offices, sells insurance, and is the largest pharmacy retailer. It also is the largest pharmacy benefit manager, and in that capacity, it decides how much to pay retail competitors and its own stores for the drugs they dispense.
CVS says it maintains firewalls between its different business units, but some competitors suspected it of driving down reimbursements in the years before the pandemic and then buying up smaller pharmacies. It then folded prescriptions from them into existing CVS operations.
The company is now in the process of closing 900 of its own stores, and testimony in the Ohio hearings over the Canton store indicated that the company added little staff to deal with the additional work.
David Burke, a former state senator who is now executive director of the Ohio Pharmacists Association, said Tuesday’s sanctions by the pharmacy board should serve as a warning to CVS to get its house in order.
“Based on the facts and in the name of safety, the Board of Pharmacy delivered its first punitive action in nearly a dozen cases against CVS,” Burke said in a text message. “The message was clear: Putting patients at risk while demeaning the practice of pharmacy is not a tolerated business model in Ohio.”
