Pharmacy frustration

Terry Roberts
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Doctor holidays delay medications; pharmacist, patient concerned

It's happened to Burin Peninsula resident Madeline Broydell and many others with chronic illnesses.

Here's how it usually plays out. Broydell is low on the medications she uses to control her diabetes and high blood pressure, but her doctor is out of town and is unavailable to write her a new prescription.

She pays a visit to Doug Stanley, a pharmacist at Burin Pharmacy, who's been filling her prescriptions for many years and knows her medical background almost as well as her doctor.

It's happened to Burin Peninsula resident Madeline Broydell and many others with chronic illnesses.

Here's how it usually plays out. Broydell is low on the medications she uses to control her diabetes and high blood pressure, but her doctor is out of town and is unavailable to write her a new prescription.

She pays a visit to Doug Stanley, a pharmacist at Burin Pharmacy, who's been filling her prescriptions for many years and knows her medical background almost as well as her doctor.

But Stanley throws up his hands. Without a written prescription from a medical doctor, he can't help Broydell.

He tells her to visit the emergency department at the local hospital in order to get a written prescription, a process that could take many hours and forces her to expose herself to an environment filled with sick, possibly contagious patients.

"It's very frustrating," Broydell said Friday from her home in Burin Bay Arm. "I've ran into this problem a couple of times.

"It seems to me that Doug should be able to help us out."

But Stanley, like other pharmacists, is unwilling to use his professional discretion these days and provide the medication because he may face severe penalties or fines if audited by the Department of Health.

His frustration reached a boiling point on Thursday when he encountered more than 20 patients in need of prescription refills, but were unable to get a prescription from their family doctor because he is away on holidays.

"I had to take those people and send them to the emergency room to get a written prescription to protect my behind so I don't get dinged on an audit," said Stanley.

Stanley believes that in circumstances like this, he should be able to use his professional discretion and provide the medications.

"I'm not asking for the right to prescribe and dispense, just to continue a prescription you've already been on, in many cases for many years," he said.

The issue has been raising the ire of primarily rural and community pharmacists for several years, ever since auditors with the province's prescription drug program began paying closer attention to the issue.

In the past, pharmacists would often help out patients they were familiar with when circumstances warranted, and often at the encouragement of the patients' physician. But such a practice violates the federal Food and Drug Act.

In some cases, claims from pharmacies to the prescription drug program have been disallowed, and one dispute ended in court with a judge ruling that the formula used by auditors to determine the value of non-compliant claims was unfair.

In light of the crackdown, most pharmacists are now inflexible when it comes to prescription refills, and Stanley believes it's causing bigger problems. For example, sending patients to emergency is an unnecessary burden on the health-care system, and some patients go without their medication and risk further complications.

Changes expected

Don Rowe, secretary-registrar with the province's pharmacy board, understands Stanley's frustration. He said discussions have been ongoing for many months, and he expects that new regulations and standards of practice will be adopted early in 2010.

Rowe said four changes to provincial pharmacy regulations have been proposed, and they all deal with giving pharmacists more discretion to act under specific circumstances, including the emergency supply of medication. He had hoped these new regulations could have been adopted before the end of this year, but said "it's always difficult to get in line to get your issues dealt with" by the Department of Health.

"It's unfortunate that we have patients caught in the middle of this," he added.

No one from the Department of Health was available for comment, but an official e-mailed the following statement:

"Section 2 of the Pharmacy Act provides that only medical practitioners, dentists, veterinarians, optometrists and nurse practitioners may give prescriptions. There are ongoing discussions taking place between the Newfoundland and Labrador Pharmacy Board (NLPB) and the provincial government with respect to medication management by community pharmacists. The NLPB is responsible for licensing of pharmacists and scope of practice and would be in the best position to comment."

troberts@thetelegram.com

Organizations: Department of Health, Newfoundland and Labrador Pharmacy Board

Geographic location: Burin Bay Arm

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Recent comments

  • M
    July 02, 2010 - 13:31

    So did the doctor go off on holidays without posting a notice to his or her patients that he or she would be away for that time period, and to come ahead of time, to get a necessary perscription renewed? If it was posted, why didn't they go and get the persciption renewed ahead of time? Pharmacists aren't doctors. Yes, they can tell you what side effects to expect while taking a medication, and how most medications are to be taken( with food, without food, number of times per day, etc) but that's it. However, i had an experience with a topical creme, and i can tell you, the doctor knew more about how that creme was to be applied, than the pharmacist did. Pharmacist...... oh, these are the side effects, and you put it on, 3 times a day - that was the extent there. Doctor....soak your hands in warm water, then apply the creme , in a very minute amount, to your wet hands,rubbing in very gently, and let air dry. TAD bit of a difference in the two stories.

    Sometimes, especially with heart or blood pressure mediacations, there HAS to be an assessment by a licenced MD, as to whether or not it is necessary to continue taking these medications, or if they have to be changed to a different doseage, even if you've been on them for a dog's age. For example, my own mother was on Blood pressure pills for 3 yrs, and then she lost some weight, rendering her blood pressure pills, not only unnecessary, but dangerous to take, as her blood pressure dropped with the weight loss. I found her, passed out on the floor of her home, and when the doctor saw her, he took her OFF the blood pressure medication immediately. She never took it again, and lived to the ripe olds age of 91. I might add that her perscription was due to be renewed, the week after she passed out on the floor. Just lucky that i found her when i did. Imagine if she had not passed out, and had the pharmacist give her an extra month of those meds..dead at 66 perhaps?
    If you want to be doctors, people, and perscribe potentially dangerous medications, then go to medical school. You are there to dispense the medication, not perscibe it, so please leave that to the MDs who have the knowledge to assess a patient fully.... and NO, i'm not a doc.

  • Doug
    July 02, 2010 - 13:31

    Hey IronHead,
    Are you trying to ruin a good thing by saying your pharmacist is breaking the law on a public message board. Man, do you have a clue?

  • chris
    July 02, 2010 - 13:27

    people need to take responsibility for their own health. If you are taking medications for chronic illnesses, ensure that you have plenty of refills or anticipate that you may run out ahead of time. don't get up saturday morning and realize you're out of pills. Also, don't put a pharmacist or ER physician in an awkward position of having to refill medications that for all they know may have been discontinued. Sadly this happens all too often.

  • peter
    July 02, 2010 - 13:26

    NL the only province you can't do this, so much for the new labor mobility law.

  • Allan
    July 02, 2010 - 13:25

    Patients should take full responsibility for their medications. If you are aware that the doctor is going on vacation, then take action prior to running out. If you are unaware that your doctor is going on vacation, then when your supply is running low, you make an appointment. When you call for an appt., you will be told this information, and every avenue will be covered. If you fail to do this, then by all means, put yourself through the ER System. And the ER Doctors should only prescibe enough medications until the doctor returns. Its your health. Take responsibility. Be proactive. Pharmacists are not MD's, no matter how knowledgeable, no matter how well they know you and your medication history. Simple solution. Common sense should be used by all patients!

  • breathing better
    July 02, 2010 - 13:24

    I have run into this problem but not because I did not have the medication on hand. I was on vacation in Newfoundland and lost my emergency inhaler. I had a prescription in BC which still had numerous refills on it, but when I went to a pharmacy in Walmart I was told that I could not get the medication, I needed to see a Dr in NL or go to the emergency room and wait to get a prescription. I contacted my pharmacist in BC and asked where the nearest wellness center was in NL which because they are a franchaise would be able to give me the refill, my Pharmacist in BC gladly gave me the information and I had my medication in a few hours.
    I for one am glad that my Pharmacist was able to act as effeciently and quickly as he did or else it would have costs me not only hours in an emergency room but also perhaps countless dollars for seeing a Dr. in a difference province.

  • Iron
    July 02, 2010 - 13:21

    My Wife and I have ran into this situation before,and had no problem.you are not looking for a new priscription,you are looking for meds that are already prescribed by your DR.Our Pharmicist lets us have enough to tide us over until the Dr returns to his office where we can get a new prescription.Then he simply deducts what he already gave us from it.Seems very simple to me.

  • wavy
    July 02, 2010 - 13:21

    This problem could be solved by the prescribing doctor simply providing sufficient prescription repeats to the patient before vacation, extented periods of leave, etc. Is this not the responsibility of the patient to ensure their meds don't run out?

    With prescription drug abuse running rampant these days, not just in Newfoundland but all over the world, I'm not sure I like the idea of giving pharmacists the power and discretion to essentially dispense whatever they want, whenever they want. How long before that gets abused?? Who's going to police the system in these prescription repeat cases to ensure pharmacists are in fact only filling repeats for patients and not dispensing new meds. Careful with this one govt...

  • Just another
    July 02, 2010 - 13:19

    Happy to see so many stating that YOU are responsible for your own health and medications for a change. All we need to do here in this province now is to demand that the Pharmacy Board be disbanded so that people are able to medicate themselves without the interference of foolish outdated regulations that only Newfoundland seems to want to hold onto.

    We all pay more than our fair share to government bloat, time to remove a few of these sponges from our taxes and let the people decide what they want to take when they are ill. We do not need to be told what is good or bad. If a drug is so bad why did the federal government permit it to be marketed to the consumers in the first place.

    Did the Pharmacy Board know that we the consumers are able to order over the counter medications from any Pharmacy in Canada and have it delivered to our homes in NL whenever we like at half the cost as we are forced to pay in this province due to the regulations and price gouging they permit? Did they know that Pharmacies outside of this province will also fill prescriptions written by NL doctors without so much as a raised eye brow, but out of province prescriptions can not be filled in this province due to the Pharmacy Boards intervention?

    Time we take back our lives and what we decide to put in them. The Pharmacy Board is a dinosaur that should have been extinct many years ago. No wonder we are still laughed at in this country.

  • BONNIE
    July 02, 2010 - 13:17

    GRANTED, The pharmacist is more familiar with the medications than the Dr. but without a prescription, their hands are tired. its not fair for patients to put the pharmacist in that position.
    OVERALL, YOUR HEALTH IS YOUR RESPONSIBILITY..... WITH THAT BEING SAID, YOU SHOULD KEEP MEDS ON HAND ESPECIALLY IF YOUR DR. IS GOING ON HOLIDAYS.

  • Blair
    July 02, 2010 - 13:14

    Albertal recently has passed a law empowering pharmacists to write certain prescriptions. Pharmacists are highly trained medical professionals. They should be allowed to write scripts at their discretion.

  • Nick
    July 02, 2010 - 13:12

    Just wanted to comment on the comments made by M. I do agree that prescribing should be left to physicians. Without a proper examination, the prescription needs of the patient cannot be decided. And pharmacists are not trained to do this. But I would contest your view that doctors know more regarding the prescriptions than the pharmacists. Pharmacists know a great deal more than a list of side effects and they know a great more than the doctors in all things regarding the medications.

    That being said you will (as you experienced) sometimes get the individual doctor who is very knowledgeable about the drugs and a pharmacist who is less so. But I think this is an exception to the rule.

    And I say this as a doctor and a former pharmacist.

  • Pharmacy Student
    July 02, 2010 - 13:11

    This is why many provinces are currently allowing pharmacists to have limited prescribing rights. It would ensure that people who take on medication daily would never be without it.

    I'm currently enrolled as a student in the Pharmacy program of Memorial University, and this is an issue that has been discussed in class many a time.

    It's a frustrating situation. The pharmacist is well educated and can often make an informed decision when it comes to their patients' health. Albeit, the physician must make the primary evaluation but as far as refills go, the Pharmacist is well equipped to make this assessment.


    Just to add - people that view the pharmacist as merely a pill counter or someone who merely reiterates what is on the label of the medication are in the wrong - It would not take a four year program to learn this. The pharmacist is the expert of the medication and can have a huge impact on the health of the patient. However the law in Newfoundland is prohibiting the pharmacists from using their full knowledge in this kind of situation. Hopefully, we will see some changes in the near future so this kind of situations will be a thing of the past.

  • M
    July 01, 2010 - 20:20

    So did the doctor go off on holidays without posting a notice to his or her patients that he or she would be away for that time period, and to come ahead of time, to get a necessary perscription renewed? If it was posted, why didn't they go and get the persciption renewed ahead of time? Pharmacists aren't doctors. Yes, they can tell you what side effects to expect while taking a medication, and how most medications are to be taken( with food, without food, number of times per day, etc) but that's it. However, i had an experience with a topical creme, and i can tell you, the doctor knew more about how that creme was to be applied, than the pharmacist did. Pharmacist...... oh, these are the side effects, and you put it on, 3 times a day - that was the extent there. Doctor....soak your hands in warm water, then apply the creme , in a very minute amount, to your wet hands,rubbing in very gently, and let air dry. TAD bit of a difference in the two stories.

    Sometimes, especially with heart or blood pressure mediacations, there HAS to be an assessment by a licenced MD, as to whether or not it is necessary to continue taking these medications, or if they have to be changed to a different doseage, even if you've been on them for a dog's age. For example, my own mother was on Blood pressure pills for 3 yrs, and then she lost some weight, rendering her blood pressure pills, not only unnecessary, but dangerous to take, as her blood pressure dropped with the weight loss. I found her, passed out on the floor of her home, and when the doctor saw her, he took her OFF the blood pressure medication immediately. She never took it again, and lived to the ripe olds age of 91. I might add that her perscription was due to be renewed, the week after she passed out on the floor. Just lucky that i found her when i did. Imagine if she had not passed out, and had the pharmacist give her an extra month of those meds..dead at 66 perhaps?
    If you want to be doctors, people, and perscribe potentially dangerous medications, then go to medical school. You are there to dispense the medication, not perscibe it, so please leave that to the MDs who have the knowledge to assess a patient fully.... and NO, i'm not a doc.

  • Doug
    July 01, 2010 - 20:19

    Hey IronHead,
    Are you trying to ruin a good thing by saying your pharmacist is breaking the law on a public message board. Man, do you have a clue?

  • chris
    July 01, 2010 - 20:14

    people need to take responsibility for their own health. If you are taking medications for chronic illnesses, ensure that you have plenty of refills or anticipate that you may run out ahead of time. don't get up saturday morning and realize you're out of pills. Also, don't put a pharmacist or ER physician in an awkward position of having to refill medications that for all they know may have been discontinued. Sadly this happens all too often.

  • peter
    July 01, 2010 - 20:12

    NL the only province you can't do this, so much for the new labor mobility law.

  • Allan
    July 01, 2010 - 20:11

    Patients should take full responsibility for their medications. If you are aware that the doctor is going on vacation, then take action prior to running out. If you are unaware that your doctor is going on vacation, then when your supply is running low, you make an appointment. When you call for an appt., you will be told this information, and every avenue will be covered. If you fail to do this, then by all means, put yourself through the ER System. And the ER Doctors should only prescibe enough medications until the doctor returns. Its your health. Take responsibility. Be proactive. Pharmacists are not MD's, no matter how knowledgeable, no matter how well they know you and your medication history. Simple solution. Common sense should be used by all patients!

  • breathing better
    July 01, 2010 - 20:10

    I have run into this problem but not because I did not have the medication on hand. I was on vacation in Newfoundland and lost my emergency inhaler. I had a prescription in BC which still had numerous refills on it, but when I went to a pharmacy in Walmart I was told that I could not get the medication, I needed to see a Dr in NL or go to the emergency room and wait to get a prescription. I contacted my pharmacist in BC and asked where the nearest wellness center was in NL which because they are a franchaise would be able to give me the refill, my Pharmacist in BC gladly gave me the information and I had my medication in a few hours.
    I for one am glad that my Pharmacist was able to act as effeciently and quickly as he did or else it would have costs me not only hours in an emergency room but also perhaps countless dollars for seeing a Dr. in a difference province.

  • Iron
    July 01, 2010 - 20:05

    My Wife and I have ran into this situation before,and had no problem.you are not looking for a new priscription,you are looking for meds that are already prescribed by your DR.Our Pharmicist lets us have enough to tide us over until the Dr returns to his office where we can get a new prescription.Then he simply deducts what he already gave us from it.Seems very simple to me.

  • wavy
    July 01, 2010 - 20:04

    This problem could be solved by the prescribing doctor simply providing sufficient prescription repeats to the patient before vacation, extented periods of leave, etc. Is this not the responsibility of the patient to ensure their meds don't run out?

    With prescription drug abuse running rampant these days, not just in Newfoundland but all over the world, I'm not sure I like the idea of giving pharmacists the power and discretion to essentially dispense whatever they want, whenever they want. How long before that gets abused?? Who's going to police the system in these prescription repeat cases to ensure pharmacists are in fact only filling repeats for patients and not dispensing new meds. Careful with this one govt...

  • Just another
    July 01, 2010 - 20:01

    Happy to see so many stating that YOU are responsible for your own health and medications for a change. All we need to do here in this province now is to demand that the Pharmacy Board be disbanded so that people are able to medicate themselves without the interference of foolish outdated regulations that only Newfoundland seems to want to hold onto.

    We all pay more than our fair share to government bloat, time to remove a few of these sponges from our taxes and let the people decide what they want to take when they are ill. We do not need to be told what is good or bad. If a drug is so bad why did the federal government permit it to be marketed to the consumers in the first place.

    Did the Pharmacy Board know that we the consumers are able to order over the counter medications from any Pharmacy in Canada and have it delivered to our homes in NL whenever we like at half the cost as we are forced to pay in this province due to the regulations and price gouging they permit? Did they know that Pharmacies outside of this province will also fill prescriptions written by NL doctors without so much as a raised eye brow, but out of province prescriptions can not be filled in this province due to the Pharmacy Boards intervention?

    Time we take back our lives and what we decide to put in them. The Pharmacy Board is a dinosaur that should have been extinct many years ago. No wonder we are still laughed at in this country.

  • BONNIE
    July 01, 2010 - 19:58

    GRANTED, The pharmacist is more familiar with the medications than the Dr. but without a prescription, their hands are tired. its not fair for patients to put the pharmacist in that position.
    OVERALL, YOUR HEALTH IS YOUR RESPONSIBILITY..... WITH THAT BEING SAID, YOU SHOULD KEEP MEDS ON HAND ESPECIALLY IF YOUR DR. IS GOING ON HOLIDAYS.

  • Blair
    July 01, 2010 - 19:53

    Albertal recently has passed a law empowering pharmacists to write certain prescriptions. Pharmacists are highly trained medical professionals. They should be allowed to write scripts at their discretion.

  • Nick
    July 01, 2010 - 19:50

    Just wanted to comment on the comments made by M. I do agree that prescribing should be left to physicians. Without a proper examination, the prescription needs of the patient cannot be decided. And pharmacists are not trained to do this. But I would contest your view that doctors know more regarding the prescriptions than the pharmacists. Pharmacists know a great deal more than a list of side effects and they know a great more than the doctors in all things regarding the medications.

    That being said you will (as you experienced) sometimes get the individual doctor who is very knowledgeable about the drugs and a pharmacist who is less so. But I think this is an exception to the rule.

    And I say this as a doctor and a former pharmacist.

  • Pharmacy Student
    July 01, 2010 - 19:47

    This is why many provinces are currently allowing pharmacists to have limited prescribing rights. It would ensure that people who take on medication daily would never be without it.

    I'm currently enrolled as a student in the Pharmacy program of Memorial University, and this is an issue that has been discussed in class many a time.

    It's a frustrating situation. The pharmacist is well educated and can often make an informed decision when it comes to their patients' health. Albeit, the physician must make the primary evaluation but as far as refills go, the Pharmacist is well equipped to make this assessment.


    Just to add - people that view the pharmacist as merely a pill counter or someone who merely reiterates what is on the label of the medication are in the wrong - It would not take a four year program to learn this. The pharmacist is the expert of the medication and can have a huge impact on the health of the patient. However the law in Newfoundland is prohibiting the pharmacists from using their full knowledge in this kind of situation. Hopefully, we will see some changes in the near future so this kind of situations will be a thing of the past.