People who have worked at the pharmacy giant Medco Health Solutions in Tampa complain of a heedless pursuit of efficiency.
By KRIS HUNDLEY
Published October 10, 2003
Medco Health Solutions Inc. has grown to be the nation's biggest mail-order pharmacy by promising to get pills to patients faster and less expensively than anyone else.
But more than a half-dozen current and former pharmacists at the company's Tampa facilities say such efficiency had a price.
They say it resulted in unrelenting pressure on pharmacists to approve up to 50 prescriptions an hour in a mind-numbing, assembly-line process. At the same time, there was less tolerance for even minor errors.
The pressure-cooker atmosphere backfired, the pharmacists say, leading to more errors and corner-cutting to get the job done.
Soraya Rodriguez, a spokeswoman for Medco in Franklin Lakes, N.J., denied the allegations, saying, "We do not speed up the process. Our first focus is quality."
Rodriguez declined to say how many pharmacists have left NetPark, one of three Medco facilities in Tampa. But pharmacists say over the past two years, dozens of pharmacists have been given a gut-wrenching choice: resign or be fired.
Medco employs more than 200 pharmacists in Tampa out of a local workforce of about 1,500.
"You could cut the tension in there with knife," said Joe Prado, a pharmacist who left Medco's NetPark facility in early September after 17 years with the company. "Morale was down to zip."
The working conditions at Medco, the nation's largest pharmacy benefit manager, have repercussions because the company processed 548-million prescriptions last year, 80-million of those through mail-order facilities such as NetPark. And if Congress passes a Medicare drug benefit, it is likely to be handled by companies like Medco that operate as a middleman between health insurers and their members.
Medco, which was part of giant drugmaker Merck & Co. Inc. until being spun off in August, was also accused of defrauding the federal government and its employees in late September, when the U.S. Justice Department joined a whistle-blower lawsuit. The complaint alleges that Medco destroyed prescriptions, switched drugs without doctors' approval and allowed non-pharmacists to perform pharmacists' duties.
Medco has vigorously denied all charges. David Machlowitz, the company's general counsel, said, "The allegations are false, overblown or reflect an isolated incident here or there where employees did not do what they should have done. And when we found out about it, we punished them."
The work load is likely to increase for pharmacists at Medco's NetPark facility, which now processes more than 200,000 prescriptions each week. Medco is closing its Las Vegas processing center over the next two months, eliminating 430 jobs and dispersing those orders over three locations, including Tampa's NetPark.
"Our strategy is to follow the path of best utilization at the best state-of-the-art facilities," Rodriguez said. "So Tampa will see some additional volume, but not additional jobs. Certainly, NetPark has that capacity."
Gregg McHugh, who said he was "invited to leave" Medco in July 2002 after 16 years, might disagree. He said the work environment deteriorated after the opening of NetPark in late 2001.
"It was a big money investment and the attitude and mentality of management was changing," said McHugh, 50. "When you saw pharmacists with 15 years or more of experience being invited to leave, you have to question the system."
Part of the issue for veteran pharmacists was the switch to all electronic order-entry at NetPark, which is on Hillsborough Avenue. When McHugh and Prado started processing prescriptions for Medco at its old facility by the Tampa airport, they held the patient's prescription in their hands. At NetPark, prescriptions go from mailbag to scanner; from that point on, it's an electronic journey.
Clerks enter a patient's personal information; the pharmacist, relying on a scanned version of the prescription, enters the drug name, dosage and frequency. By hitting a button, the pharmacist sends the order through cyberspace to any one of three Medco dispensing centers in Las Vegas, New Jersey or Tampa's Sabal Park.
The high-tech system can be efficient but unforgiving. If a pharmacist realizes he has misspelled the patient's name or mistaken the dosage after hitting the send button, he's out of luck. The order is gone, and an error, known as a "Class A," goes in the personnel file. Some pharmacists said they were told they'd be asked to leave after as few as three errors in six months; others said the firing threshold kept changing.
"It was like they were taking pot shots or targeting people," McHugh said. "And you'd be accused of errors months after they occurred and you couldn't go and put our finger on what happened."
The options for preventing errors were few, ex-pharmacists said.
If the pharmacist wanted to question something on a prescription - the strength or dosage, for instance - it wasn't a matter of simply picking up the phone. Dubious prescriptions were diverted to other workers in the "doctor call" area. And pharmacists who forwarded too many prescriptions for doctor calls say they were hauled in by supervisors for trying to "defer work."
"Pharmacists are pressured to resort to guesswork and not to send the prescriptions to Doctor Calls to reduce costs," one Medco pharmacist wrote in a letter to Sen. Bill Nelson in May.
Making calls to doctors to verify prescriptions was unpopular with management because it slowed the process. And from the minute a prescription was logged into a Medco facility, the clock started ticking. Under its contract with the federal government, Medco agreed to dispense 99 percent of all prescriptions within five days of receipt or pay penalties.
That intensified the pressure to move things along and, the government's lawsuit and several employees allege, cut corners.
Prado said the company routinely canceled prescriptions that were awaiting a doctor's return call rather than let them show up on reports as late shipments. He said in one instance, when a doctor's office faxed a revised prescription after the original already had been canceled, his supervisor asked him to simply destroy the fax. "I refused," Prado said.
Medco has denied allegations that prescriptions were destroyed.
Some pharmacists seemed better able than others to handle the monotony of computer work, attacking the work like a video game. Ken Shobola, who held a second full-time job while working 40 hours a week as a Medco pharmacist, described the work rate of up to 45 orders per hour as "not an impossible or overly ambitious expectation."
But Shobola, who served for two years as union president, said he often heard complaints from colleagues who felt pressured to work faster. And he said that though there were high hopes NetPark's computerized system would reduce Medco's error rate, he doubts that has happened.
"Initially we did great, but then the monotony factor set it," said Shobola, who now runs a chain of medical clinics in the Tampa Bay area. "You tend to get sleepy."
Medco may be acknowledging it has some problems. A consulting company recently interviewed a number of pharmacists in Tampa, asking about workplace issues. And some say the quota pressure has lessened in recent weeks.
But some customers say errors and irritating mistakes are still happening. Stuart Posner of Tampa said despite several tries, he can't get anyone at Medco to fix his recent order for an arthritis remedy. He was charged the co-pay for a 90-day supply of pills, but received only a 20-day supply.
"You're dealing with a multibillion-dollar organization and you've got no place to go but a $5.50 an hour clerk that answers the phone," he said. "Then you get in a complicated conversation and the phone is disconnected. Accidentally. Repeatedly."
After Cathy Davis of St. Petersburg failed to receive her medicine in the mail not long ago, she was surprised to be told by Medco employee that her prescription had been inexplicably "canceled."
And Bill Molnar, a retiree in St. Petersburg, is frustrated that they sent him a brand-name cholesterol-reducing drug, instead of the less expensive, generic version prescribed by his doctor. "I offered to return the medicine, but they said, "Oh no, we can't take medicine back,"' Molnar said. "But they sure as hell can charge me."
Medco's spokeswoman said it is unfair to criticize the company, which had $33-billion in sales last year, on the basis of three customer complaints. "One in four Americans receive our services," she said. "You should allow us to validate those complaints."
Prado, who was given the option by the company in September of retiring at age 57 or being fired, said the pharmacists at Medco understand there is no such thing as an acceptable error in the pharmacy industry. "But there are certain situations where errors should merit a heads-up, rather than being used as a tool to fire someone," he said. "At Medco, that caused a tension which, long-term, may have caused a lot of people to be preoccupied with keeping their jobs. That, unfortunately, may have led to more errors."
- Times researcher Kitty Bennett contributed to this report. Kris Hundley can be reached at hundley@sptimes.com or 727 892-2996.
