Ohio attorney general: Put Jackson Township CVS store on probation for risks to patients

Editor's note: The following article was originally published by the Ohio Capital Journal and is available to the Canton Repository under a content-sharing agreement.

A deputy attorney general working for the Ohio Board of Pharmacy has recommended the board fine CVS and place a store it operates in Jackson Township on probation for “a period of years” after inspectors in 2021 found risks to patient safety due to understaffing.

Attorneys for CVS blamed the problems on the coronavirus pandemic. But board of pharmacy inspectors found similar problems at a dozen other CVS stores in Ohio — some occurring as recently as last year.

Problems have also been reported at CVS stores in other states. They raise questions about whether they’re due, as CVS contends, to a shrinking labor pool and increasing demands, or whether they’re the product of relentless cost cutting and consolidation by the company.

When Board of Pharmacy inspectors visited Jackson Township store No. 2063 at 7292 Fulton Drive near Wales Avenue NE on Sept. 13, 2021, they found a pharmacy so understaffed that the inside counter was closed, the phone wasn’t working and the line of cars to the drive-thru snaked around the side of the building.

Stock — including controlled substances — hadn’t been shelved. The staff was so harried that it took inspectors 20 minutes to get somebody’s attention, according to the report, which CVS hasn’t disputed.

Inspectors found that it took almost two weeks for the overwhelmed pharmacy to fill many prescriptions. And on a follow-up call a month later, they were told the backlog for some was a full month.

During that period, the pharmacy also filled a prescription with the wrong medication. The patient was supposed to receive a statin to control cholesterol, but instead got the hypnotic sleep drug commonly known as Ambien. Fortunately, the mistake was detected before that person took the medication and went for a drive.

Ohio Board of Pharmacy hearings

Thursday’s hearing was a continuation of one that began in November, and the pharmacy board isn’t expected to make its decision until next month, when it will also take up allegations against another Ohio CVS store. But the penalties it can impose range from a small fine to revocation of the store’s license — and that decision could indicate how hard a line it will take in subsequent proceedings.

The hearings come after the pharmacy board in July released citations against eight CVS pharmacies in response to a records request from the Capital Journal. The board subsequently released citations against five others. They detailed problems similar to some of those alleged at the Jackson Township store — and some revealed losses of controlled substances such as opioids.

On Thursday, lawyers for CVS put on testimony from Dennis McAllister, an expert witness who has worked as a pharmacist in many roles and who served for decades on the Arizona State Board of Pharmacy.

He said that after viewing some of the earlier hearings and reviewing the inspection reports, he believed the problems suffered at the CVS store in Jackson Township were severe but emblematic of what was happening in the industry nationwide.

The number of pharmacists and pharmacy technicians had been going down for a decade. Then COVID hit, making workers reluctant to work on the frontlines just as the workload spiked with pharmacies giving COVID tests and administering vaccines, McAllister said.

“The industry in general wasn’t able to do stuff in time,” he said.

McAllister praised the hard work of the employees at the Jackson Township store and credited it with quickly fixing problems inspectors found there. But CVS might have something to do with the diminishing pay and more-harried working conditions that have beset the industry, likely leading to the diminishing number of students entering pharmacy school, he said.

CVS stores in Ohio and understaffing

The chain increased the number of pharmacies it owns from 5,474 in 2005 to 9,939 in 2021, according to the German data-gathering firm Statista. Much of that has been from aggressive acquisition of competing pharmacies, closing them and moving their prescriptions to an existing CVS store.

In Thursday’s hearing, board member Tod J. Grimm pointed out that the Jackson Township CVS absorbed the prescriptions of two other pharmacies but only increased pharmacists’ hours there by two per week.

And at least after the worst of the pandemic, CVS employees said that understaffing CVS stores wasn’t due to a labor shortage, it was a choice.

“Understaffing is pretty deliberate from our upper and middle management,” Iggy Aleksick, a pharmacy technician at a CVS in Bowling Green told the Capital Journal in August, explaining that management wouldn’t OK additional hours even though workers were available.

And while McAllister made much of the burden created at the Jackson Township store by giving COVID and flu vaccines, CVS employees said the company relentlessly pushes the services because they’re a source of revenue.

Simon Souhrada, a technician at the CVS in Mount Vernon until last June, said it was frustrating to be ordered to make phone calls as the prescription backlog there grew.

“It was all calling people, trying to sell them on vaccines and we would get daily emails demanding that we go faster and faster on these things while the queue (of unfilled prescriptions) was piling up and there was no one to fill it,” he said. “She just focused on all the wrong things and didn’t do anything to help.”

Kristina Dahmann, an attorney for CVS, has relentlessly tried to keep the focus in the hearing on the fact that the problems at the Jackson Township store arose at the height of the pandemic. In her closing statement, she pointed out that the state requires no minimum level of staffing at pharmacies, and that weeks-long backups filling prescriptions don’t necessarily mean that patients are waiting that long for their medicine.

“Numbers alone don’t tell the story,” she said.

But in their questioning of McAllister, the expert witness, members of the pharmacy board seemed skeptical of claims that the problems inspectors found at the Jackson Township CVS were typical of pharmacies everywhere. All but one are pharmacists themselves, and independent pharmacists have said that while the pandemic was challenging, it didn’t lead to anything like the delays or chaos that the Board of Pharmacy found at numerous CVS stores.

It’s also unclear whether, as they assess the evidence of what happened at the Jackson Township CVS in late 2021, the board will view it in isolation. While Dahmann insisted that problems there were due to the exigencies of the pandemic, board inspectors continue to allege dangerous conditions due to understaffing at Ohio CVS stores.

In November, inspectors cited three stores for violations in 2023, including six-day backlogs filling prescriptions, dirty conditions and losses of hundreds of doses of the painkiller tramadol.

This article originally appeared on The Repository: Ohio attorney general asks that Jackson Twp. CVS be put on probation