Board ponders mandatory breaks for pharmacy staffs

The board that oversees Minnesota pharmacists will take public comments Wednesday on a proposal to mandate breaks for pharmacy staff, a move intended to protect the public from fatigue-induced medication errors.

Pharmacists say it's common for them to work an entire shift without a single break — sometimes not even for a trip to the bathroom. Dozens of them have written letters and emails to the Minnesota Board of Pharmacy to support the proposal.

Some shared disturbing details of their own indignities dealing with grueling schedules that often require them to work 12 to 14 hours or more.

Pharmacist Chantel Scherman wrote that she has been distracted from her work on many occasions by hunger, shakiness, lightheadedness and sweating because there was no time to eat during her busy shift. Scherman declined an interview request but wrote this for the public record:

"I've been denied the opportunity to use the restroom, even during menses, for which on one devastating occasion, led to leaking a pool of blood all over the pharmacy floor."

Scherman's story is one of the most extreme Cody Wiberg has come across. He's executive director of the Minnesota Board of Pharmacy. Wiberg said another pharmacist recently told one of the agency's inspectors that he often resorts to using a plastic cup to relieve himself.

"That's certainly something we don't recommend," Wiberg said. "But this gentleman ... felt he didn't have a choice."

Wiberg can't verify the account of either pharmacist. But the stories seem plausible to him, based on his own experience working behind the counter.

"There were many, many times when I was on the way back to the bathroom and the intercom would come on, 'Cody, please return to the pharmacy,'" he said. "So you had to make a decision as to whether or not is this something so important I need to go back, or can I go to the restroom?"

Insurance payments for drugs have declined, cutting into pharmacy profits. In response, businesses have cut staffing to minimum levels. But Wiberg said if pharmacists can't meet their own basic bodily needs, patient safety is at risk.

"It sort of does make common sense that if they're working those sort of shifts with no breaks, they are going to be more likely to make errors," he said.

Minnesota's proposed work rule is adapted from a North Carolina regulation that was settled by that state's Supreme Court. Justices in the case ruled that there is a relationship between mistakes and long unbroken shifts.

The Minnesota Board of Pharmacy is investigating at least a half-dozen cases in which a very heavy workload appears to have contributed to dispensing errors, Wiberg said. He can't share specifics because the cases are still open.

The board is proposing a mandatory 30-minute uninterrupted meal break, plus another break of 15 minutes in any shift longer than six hours. Shifts of 12 or more hours would be an option only in an emergency or with the employee's consent.

Pharmacies and retail trade groups are pushing back hard, disputing claims that pharmacy employees don't get bathroom and meal breaks. The board has received dozens of letters saying the proposed work rules are unnecessary, onerous and bad for business.

Jeff Lindoo, a vice president at Thrifty White Pharmacy, said the proposal would mean "very, very poor patient and customer service."

Thrifty White operates 51 stores located predominantly in rural areas of the state.

Lindoo said 21 of Thrifty's pharmacies have a single pharmacist. Under state law, no first-time prescriptions can cross the counter unless a pharmacist is present to counsel the patient.

Thrifty White's personnel manager, Dave Rueter, said operations might have to stop serving patients when a solo pharmacist is taking a required break.

"To come to the pharmacy and find it closed for 30 minutes in the middle of the day, I think would be a real hardship for [patients] and one I think they would not like," he said.

At a minimum, Lindoo and Rueter want the board to drop one of the two required breaks, so that small pharmacies wouldn't need to close two or even three times in a day. Pharmacy and retail groups want the board to mandate breaks after nine or 10 hours of work instead of six.

This is the board's second attempt to require breaks. An effort five years ago lacked support from the administration of Gov. Tim Pawlenty. Gov. Mark Dayton's administration has not weighed in yet.