Support for pharmacy school grows

When he made a mistake in filling a prescription that would cost a man his life, pharmacist Davidson Okpukpara remembers he was in his eighth straight day of working 12-hour shifts without lunch breaks.

"It was supposed to be my day off, but I had to come in," Okpukpara said recently by telephone from Reno. "When you work so much, I think you lose some of your mental capacity. Your focus is limited."

Medication errors like Okpukpara's tragic 2005 mixup, described in an official Nevada State Board of Pharmacy report as "a misfill that resulted in death," help crystalize a need for a public school of pharmacy in Nevada, according to Iain Buxton and Robert Sullivan, founders of the Pharmaceutical Education and Research Foundation of Nevada.

The foundation is a nonprofit corporation supporting the opening of an accredited school of pharmacy and pharmaceutical sciences at the University of Nevada.

But others in the industry say that although pharmacy errors are a concern, it's not clear that having more pharmacists in Nevada would help. And larger pharmacy chains dispute the notion that Nevada's pharmacists are overworked.

Jody Cook, a Rite Aid spokeswoman, said this is not the case at the chain. And Walgreens spokeswoman Carol Hively says her company's pharmacists normally work a standard eight-hour day, and no longer than 10 "by choice." And many of the state's pharmacists work only part time as well.

Though 140 pharmacists graduate from the University of Southern Nevada School of Pharmacy in Henderson each year, Buxton said it's not enough.

"We have to have more pharmacists in Nevada, including pharmacists who go into the kind of research that helps attract biotech companies and jobs to Nevada, or suffer the consequences," he said.

Buxton, in addition to his position with the foundation, is a professor of pharmacology and obstetrics and gynecology with the University of Nevada School of Medicine as well as planning dean for a new school of pharmacy.

Statistics compiled by the pharmacy board show five deaths resulted from incorrectly filled prescriptions since 2000 and 15 cases of serious injury to a patient.

The pharmacy board is also studying the case of a baby who died this year after a prescription was apparently misfilled.

Pharmacy board executive secretary Larry Pinson said it is unknown how many medication errors can be attributed to overworked pharmacists.

The pharmacy board hands out disciplinary action to pharmacists and their employers.

Auburn University's Dr. Ken Barker, one of the nation's leading experts in studying pharmacy error rates, said no research has shown a direct correlation between overworked pharmacists and mistakes.

"It seems to makes sense," he said by phone from his Alabama home. "But we don't have the data for that yet."

Sullivan, a former executive with the Eckerd Drug chain, said the current workload for Nevada pharmacists "is creating a dangerous situation because of fatigue."

Okpukpara, a former Rite Aid pharmacist now working for Scolari's Food and Drug in Reno, concurs.

"Bad things happen when you get tired," he said. "I think you get a little lax."

A peer-reviewed study headed by Buxton in 2005 found that Nevada has 72 pharmacists per 100,000 population. Seventeen states have between 83 to 105 pharmacists per 100,000 people, according to a 2006 report by the Health Resources and Services Foundation. That same report shows 16 states average from 76 to 83 pharmacists per 100,000 population, with the remaining states, including Nevada, bringing up the rear.

According to the national Pharmacy Manpower Project, only five states, including California, have a greater demand for pharmacists. Pharmacists just graduating from college often command salaries in Nevada of up to $130,000, with a $30,000 signing bonus, Buxton said.

Still, Walgreens' Hively noted, the chain was able to carry out a 44-store expansion in Nevada and manage to fill all their pharmacist positions.

Ron Horvath, owner of Village East Drugs in the southern valley, said it is virtually impossible for an independent store like his to compete with chain outlets. Horvath said he's had the same employees for 10 or 12 years, but it will be hard for him to replace them should they leave. The problem, he said, is not that there's not enough pharmacists; it's "just what we have to pay them."

Prescription errors are a national problem. Even using the most conservative error estimate of 1.7 percent projected in the prestigious Institute of Medicine's 2006 report, there would be 51.5 million errors made nationwide during the filling of 3 billion prescriptions annually.

The study found those errors injure 1.5 million people a year, and researchers have found that more than 125,000 Americans die from drug reactions and mistakes each year, making pharmaceuticals the fourth-leading national cause of death.

Pharmacist Joe Kellogg of Las Vegas said it's critical that pharmacists be able to focus on their work. Nearly illegible handwriting by doctors can cause mistakes on prescriptions. So can drugs with similar sounding and looking names like Celebrex, Celexa and Cerebyx, each prescribed for unique conditions.

"We don't have just a crisis on our hands when it comes to prescription drugs," said Fred Mayer, president of California-based Pharmacists Planning Service Inc., a nonprofit public health organization. "We're in the middle of an emergency."

But Mayer isn't sure that more pharmacists gets to the heart of the problem. He believes that managed-care companies, which will only pay for a 30-day supply of drugs, share much of the blame.

"If they would pay for 90-day supplies, there wouldn't be such a strain on pharmacists for prescriptions," he said.

Pinson said health care companies don't like to pay for three months of drugs, because an employee may leave his company.

"Insurance companies don't want to pay for something they don't have to," he said.

The ever-increasing number of prescriptions given to Americans also places increased importance on pharmacy technicians.

Until last year, Pinson said, the technicians weren't required to have formal training. Someone who had been digging ditches one day could be filling prescriptions the next. Pharmacists are required to oversee their work, however.

Because the technicians caused a "disproportionate" amount of medication errors, particularly when entering information in a computer, the pharmacy board decided to require training that "generally lasts a year or two at a business school," Pinson said.

The technician-in-training must then complete 1,500 hours of training with a pharmacist before he can become registered in the state as a technician.

Buxton said technicians should have to pass a national certification test before working with a pharmacist.

He pointed to another case involving a baby who had to be hospitalized because a technician-in-training confused a 7 mg dose with a .07 mg dose.

"We're relying way too much on technicians who have questionable training," he said.

To Buxton's chagrin, the chances of a new public school of pharmacy in Nevada appear to be slim.

Marsha Turner, interim vice chancellor and chief operating officer of the University of Nevada Health Sciences System, said that Gov. Jim Gibbons' budget simply won't allow a new program.

"A pharmacy school would be great for Nevada, but we have to deal with our priorities right now, and that's working to increase the number of nurses and physicians in Nevada," she said.

Bill Welsh, head of the Nevada Hospital Association, agrees the need for nurses is a high priority, yet the need for pharmacists "may be greater."

He said hospitals often must hire pharmacists on a temporary basis to fill open positions, which "is very costly and eventually gets passed on to consumers."

Renee Coffman, dean of the University of Southern Nevada School of Pharmacy, isn't sure another pharmacy school will work in Nevada. She said it's already difficult to fill faculty positions and to find clinical sites where students can work.

Coffman also said she isn't sure there is a correlation between pharmacists filling a large number of prescriptions over a long period of time and mistakes.

"I'd like to see all the data on that," she said, adding that it is possible a pharmacist working in a "slow store" may make mistakes because he is bored.

Okpukpara said he definitely wasn't bored in November 2005 when he made the mistake that proved fatal. The name of the victim has not been released because of federal privacy laws.

"I had already done more than 150 prescriptions" that day, he said.

Board secretary Pinson recalls that Okpukpara was choking back tears as he took responsibility for the November 2005 error that occurred when he filled a prescription for a Northern Nevada man who had had surgery on his nasal passages and throat.

The prescription called for the pain reliever Roxicet, a combination of acetaminophen and oxycodone, a narcotic analgesic related to codeine. Instead, Okpukpara filled the prescription with the far more potent, but similar sounding and looking painkiller Roxanol, or morphine.

During a pharmacy board meeting, a caregiver for the deceased said she gave her friend two teaspoons of the drug as prescribed at 11 p.m. By 6:15 a.m., her friend had stopped breathing.

The pharmacy board's punishment for Okpukpara included fines that totaled $3,750 and two years probation. Rite Aid was fined just over $3,000 and also placed on probation for two years.