Miss. Board of Pharmacy adjusts Technician Ratio to 3:1

The Mississippi Board of Pharmacy (MBOP) has updated the pharmacy regulations to allow for the greater use of technicians in all pharmacy practice settings.  The official update reads as follows:

UPDATE ON PHARMACY TECHNICIAN/PHARMACIST RATIOS

Revisions to the Pharmacy Practice Regulations regarding the increase in Pharmacy Technician/Pharmacist ratios have been completed and effective August 1, 2016, the ratio is three Pharmacy Technicians to one Pharmacist. This ratio applies to all practice settings. Please bear in mind that, regardless of the ratio, that those tasks authorized to be conducted by Pharmacy Technicians may only be performed under the direct and immediate supervision of a Pharmacist. It is the responsibility of the Pharmacist-In-Charge as well as supervising pharmacists to provide supervision of duties of the pharmacy technician and to prevent pharmacy technicians from performing those functions relative to dispensing which are functions based on a judgement for which the pharmacy technician has not been prepared by education or authorized by law or regulation. The Pharmacist-In-Charge (PIC) is responsible for assuring that all personnel are properly registered with the Board. If you have questions concerning ratios or approved tasks of a Pharmacy Technician please contact the office of the Board.

I imagine most large chains (Walgreens, CVS) will take advantage of the new ratio to reduce the number of pharmacists on staff at any given time and, consequently, save on labor costs.  This may not be a wise decision in the long run.  The claim has always been that using technicians will allow the pharmacist more time to spend with the patient and/or giving immunizations.  We’ll see.  I have heard that line in one form of the other for 25 years now and it never seems to work out in the pharmacist’s favor.  But, to be fair, it may be a way to hire more support staff when hiring a second pharmacist doesn’t make sense economically.  That may acutally help save jobs long term.

It may also be that the MBOP has finally recognized that this ratio has probably been the norm for many years now and it really can’t justify assessing fines because nobody is following the rule.  At least now, those who were trying to follow the rule but really struggled to keep up with the demands can release a general sigh of relief.  Though to me there will always be a bit of arbitrariness to the rule.  What is to say a 4 to 1 ratio is reasonable?  5 to 1? Why do we need prescriptions anyway?  Do other first world nations have such a dis-functional prescription drug distribution apparatus in place?  Like many other things in life, question everthing, even if you don’t get the answer you like.

James P. Tinsley, RPh, J.D.

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Mississippi Senate Bill 2306 tells your Sheriff how to do his job

Bouc émissaire, Juden…

Here we go again. Phil Bryant (PB) and his cronies have all the answers on how to end illegal immigration.  With all the grandstanding and the dubious participation by the “Guvener” in United States v. Texas (without approval or consent of Mississippi’s top elected attorney, Jim Hood, as far as we know), the temptation to find a scapegoat for all of Mississippi’s problems knows no limits.

Senate Bill 2306, introduced by Senator Sean Tindell for Gulfport, requires all law enforcement agencies (LEA) to affirmatively notify “federal immigration authorities” (whoever that may be, there are at least five different federal agencies that could be, but who really cares anyway) that someone in their jail is “not legally present in the United States.”  I’ll call them FIAs for short, but the lack of precision in this is stunning.  I guess if you sent President Obama an email that a guy named José is in the Newton county jail that would count as notifying a FIA.  Who knows for sure.

Despite the lack of precision, this bill places a specific legal duty on your county sheriff, chief of police, state trooper, etc. to somehow let FIAs know that a person is not here in the US “legally.”  So now, the agency has to determine if someone is not legally in the US.  Last time I checked that was something that those vaguely identified FIAs had the sole authority to determine pursuant to federal law, and, by the way, the Constitution of the United States.  (like Professor Cochran used to say: Who needs a constitution among friends anyway? It just makes life harder.)

So I am at a loss as to how the LEA is supposed to determine if a person is not legally in the US.  Of course, the detainee can tell you.  But in the absence of that, how will the LEA know when and when not to “notify” the FIAs?  Doesn’t speak English?  Has darker colored skin? Doesn’t have any identification?  Has a weird last name?  Exercises his 5th amendment right to remain silent? Can’t tell you who won the World Series last year? Doesn’t celebrate Confederate Pride Month (CPM) in April?  I simply don’t know.

Then the bill goes on to require the LEA to “fully honor” a detainer placed by FIAs.  Again the lack of precision makes this bill fertile ground for abuse.  I suspect that the word “detainer” refers to DHS Form I-247, Immigration Detainer-Notice of Action that requests a LEA to “Maintain Custody of Alien for a Period not to exceed 48 hours.”  Federal case law as well as precedent from SCOTUS has held that Form I-247 is merely a request and is not mandatory. See, Galarza v. Szalczyk, 745 F.3d 634 (3d Cir. 2014) (citing, Printz v. United States, 521 U.S. 898 (1997) that struck down most of the Brady Bill as violating the 10th amendment).  To hold otherwise would be tantamount to the federal government nationalizing the state police.  I doubt PB would go for that given his love for President Obama and Attorney General Loretta Lynch.

So, this bill scuttles the distinction between the federal and state spheres of authority over the detention of criminal defendants in county jails and effectively deputizes state LEAs as extensions of the Federal Government.  So, now your local sheriff is no longer allowed to exercise his/her professional judgment as to whom to keep in his/her jail.  The sheriff is now a de facto immigration officer thanks to this unnecessary piece of political theater.

Of course, SB 2306 will be enforced consistent with federal law and “protecting the civil rights of all persons.”  Why is this in there?  Isn’t that always the case?  Do LEAs need to be reminded that they are sworn to protect the civil rights and dignity of ALL persons?  Have we become such a police state that we have to legislate what the constitution already requires?  My thought is that there is a perception out there that persons who are not “legally present” in the US have no rights whatsoever and cannot complain later if they are not treated the same as others.  “Those” illegals have no rights!  There illegal!  The Constitution doesn’t apply to them!  Thanks for reinforcing that idea, PB and Senator Tindell.

Under federal law, a LEA is only required to keep a suspected alien for 48 hours if it chooses to do so.  If a LEA detains a person beyond this time, the LEA and the individual officers are subject to liability for violating federal civil rights statutes, even if the detainee is not legally present in the US.  So, despite the dubious need for this legislation, if a LEA detains someone beyond 48 hours, it does so at its peril and SB 2306 will not immunize the LEA against liability despite its attempt to do so in section 4 of the bill.

The last clause of section three states: “and respecting the privileges and immunities of United States citizens.”  What the ___ does this mean?  Oh, I guess it would not be good if a FIA deported a US citizen.  That never happens because LEAs are provided with so much guidance on how to determine if someone is legally present in the good ole USA.

Reality check:  FIAs deport as many as 4000 US citizens each year.  FIAs have deported US citizens despite clear and obvious evidence of US citizenship.  The FIAs and the LEAs have been sued and paid out large settlements for their blatant disregard for basic human rights.  It is hard to distinguish between incompetence and outright willfulness in those cases, but SB 2306 certainly doesn’t provide any guidance on the issue.

If you want to protect your basic human rights you must protect the basic human rights of all persons, citizens and non-citizens.  History is replete with politicians finding a venerable group to blame for all that is wrong.  Mississippi has bigger problems than illegal immigration.  The story is different for border states like Texas and Arizona, but Mississippi’s foray into this issue is simply political scapegoating and the use fear as a means of political power.  Beware the politician selling fear.  She is selling snake oil that doesn’t cure anything.  Likewise, SB 2306 does nothing to solve the problem of illegal immigration.  Violent criminals who are US citizens are let out of jail all the time and go on to commit other heinous crimes as well.  The connection between illegal immigration and violent crime in general is the very definition of a non sequitur.

Mississippi has a dreadful history with regard to human rights and therefore has a special duty to be exceedingly vigilant guarding those rights of all people.  In 2016, poverty is rampant in large parts of the state, on par with many third world countries.  I have been told by immigrants from Mexico that they would rather live in Mexico than live in certain parts of Mississippi because the standard of living is higher in Mexico.  Not something to be proud of folks.

So, maybe our time would be better spent regulating fantasy football or celebrating CPM?

Tchüss!

James P. Tinsley, Esq.

What happens when my doctor loses her license?

Patients have many questions about what to do if their doctor dies, loses his/her license to practice medicine, or moves to a different area.  Pharmacists are also put in a bind because of their legal duty to fill prescriptions from practitioners authorized by law to practice medicine. For a prescription to be valid and meet the basic requirements to be filled, there must be a bona fide, ongoing, doctor-patient relationship.  When that relationship terminates for whatever reason, what happens to prescriptions that may still have refills, but the patient is not due to return to the provider any time soon?

It is not that the pharmacist doesn’t want the patient to have his/her medicine. Quite the opposite, in fact.  There is no “gotcha” game that pharmacists play to try to get points for finding ways not to dispense a prescription to a patient.  In Mississippi, here is what the Board of Medical Licensure administrative rules say about medications (new prescriptions and refills) and when a prescription in no longer valid and, consequently, cannot be filled or refilled by a pharmacist:

Rule 1.11 Prescription Guidelines – All Medications. In addition to any other requirements set forth in these rules pertaining to the issuance of prescriptions of controlled substances, the following additional requirements apply to all prescriptions, whether or not said prescriptions are for controlled substances, legend drugs or any other medication:

G. A prescription shall no longer be valid after the occurrence of any one of the following events:
1. Thirty (30) days after the death of the issuing physician.
2. Thirty (30) days after the issuing physician has moved or otherwise changed the location of his or her practice so as to terminate the doctor/patient relationship. Termination of the doctor/patient relationship results when a patient is no longer able to seek personal consultation or treatment from the issuing physician.
3. Insofar as controlled substances are concerned, immediately after loss of DEA Controlled Substances Privilege by the issuing physician.
4. Immediately after revocation, suspension or surrender of the physician’s license.

Thus, there are many ways prescriptions that have been written by your prescriber and that you have been taking for many years may no longer be fillable by the pharmacy.  When these things happen, the patient needs to find another provider who can write the prescriptions for the patient going forward. This is Mississippi law and is not your pharmacist’s fault.  The law applies to everyone, yourself included.  Make the effort before you run out of medication to avoid any gap in taking your medications.  As with most everything else in life, you are responsible for your own well being.  Trying to shift this responsibility to your pharmacist will only delay the process.

Thanks to the Mississippi Board of Pharmacy for sharing this information with me.  This came in response to a physician who is prohibited to practice medicine in Mississippi.  If you have any questions, please feel free to call my office at 662-350-3971.

James P. Tinsley, Rph., J.D.