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    Desperate measures


    David Stanley, RPh
    It would be easy to think of someone who goes on a hunger strike against a company like Medco, the PBM giant that manages prescription benefits for almost 20% of the American population, as a crackpot. I'll admit that when I first heard of Rajendra Bhat, a former Medco pharmacist who has done exactly that, it was the first thought to come to mind. There is no shortage of crackpots in this country after all, and denying yourself food to protest the policies of a corporate behemoth seems a bit ... extreme.

    My second thought was how ironic it is that a pharmacist would voluntarily go on a hunger strike, when so many of our employers impose mini-hunger strikes on us every working day through short staffing.

    Bhat was fired in 2005 from his position as a staff pharmacist at a Medco facility in Tampa, Fla., he said for protesting a quota system that required pharmacists to process 45 to 55 prescriptions an hour. The suggestion of quotas at large mail-order pharmacies doesn't exactly sound like the tale of someone talking through his tinfoil hat. It actually sounds quite ... plausible. I decided to write Medco to ask whether it does in fact use a quota system. This is exactly what was e-mailed back:

    "No. Medco does not use a quota system."

    Pretty cut-and-dried. As much of a flat-out denial as I've ever seen. Which is why I was a bit confused when I read in the Indianapolis Star that Medco pharmacists in New Jersey turned down a contract offer from the company in part due to "unreasonable production requirements." "Production requirement" sounds an awful lot like "quota system" to me.

    Bhat also claims that Medco's policies were responsible for a prescription-fill error rate that increased from 25 per million to 300 per million. In my e-mail to Medco, I asked whether it disputed those numbers. Again, this is exactly what was sent back:

    "Mr. Bhat's claims and allegations were thoroughly investigated by the Medco Office of Ethics and the Florida State Board of Pharmacy and were founded [sic] to be without merit or foundation. His allegations were also dismissed by the court."

    This answer seems a little less cut-and-dried to me. I should think that if the numbers were wrong, all you would have to do is say they were wrong. I find the lack of a flat-out denial interesting.

    One thing Medco is right about is that Bhat has had his day both in court and in front of the Florida Board of Pharmacy. A letter signed by more than 40 Medco pharmacists led to an investigation by state authorities that went nowhere, and a subsequent lawsuit filed by Bhat was dismissed. Which is exactly the kind of thing you would expect to happen to an oddball.

    Keep in mind though, that there is nothing in the law that says an employer can't set up a prescription quota system or a quota system that's called a "production requirement."

    So perhaps Bhat, in the 65th day of his hunger strike as this article is posted to the web [September 7], is a man who, as they say back home, "isn't wrapped real tight," someone bent on self-destruction as an overreaction to workplace frustrations that we all face. Or maybe he's a warning. A sign that pharmacy is not moving in the direction of medication therapy management, increased patient contact, or interaction with other healthcare professionals, as the leaders of our profession would like us to believe, but is instead becoming little more than factory work, heading toward the same production methods that gave us the runaway Toyota Prius. Either way, he is a man desperate to be heard.

    Perhaps we should listen. The next time you're on one of those involuntary hunger strikes at work, looking at a line of prescriptions and watching a graph on your computer screen change color to let you know you're not filling them fast enough, maybe you should think about what Bhat is doing.

    Because he may be an oddball, but that does not necessarily mean he is wrong.

    David Stanley is a practicing community pharmacist in California. He can be reached at
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    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]