Ambitious legislation in the Illinois House would restrict the hours pharmacists can work each day, limit the number of prescriptions they can fill each hour, require break time during their shifts and provide whistleblower protection if they expose safety problems. But the bill already is drawing heavy opposition from lobbyists and skepticism from Gov. Bruce Rauner.

The measure represents one of the nation's most aggressive responses to concerns from pharmacists that growing pressure to work faster increases prescription drug errors.

The move comes as states beyond Illinois mandate break time. A rule is in the works in Minnesota to require bathroom and meal breaks; pharmacists there complained they are afraid to drink liquids during a shift because they may not have the time to go to the washroom.

Filed last week, the House bill is the latest reaction to a Tribune investigation that found half of 255 pharmacies tested in the Chicago region failed to warn about prescriptions for potential drug interactions that could be harmful or fatal.

"It is just a matter of time before there will be a major catastrophe," said Rep. Mary Flowers, D-Chicago, the bill sponsor and longtime chair of the House Health Care Availability and Accessibility Committee.

The union-backed legislation began taking fire from the pro-business pharmacy lobby even before Flowers could set a date for hearings.

"You might have to rent Soldier Field to hold all the people who will show up to defeat this bill," said Bob Stout, president of the New Hampshire Board of Pharmacy, who said he fought the pharmacy lobby for four years in his state before he won a 30-minute break for pharmacists who work more than eight hours.

New plan aims to protect Illinois pharmacy customers from dangerous drug interactions Ray Long and Sam Roe

Responding to a Tribune investigation that found drugstores frequently failed to warn customers about potentially dangerous drug interactions, Gov. Bruce Rauner is unveiling a major plan designed to improve public safety at pharmacies throughout the state.

The administration's proposal would require...

Responding to a Tribune investigation that found drugstores frequently failed to warn customers about potentially dangerous drug interactions, Gov. Bruce Rauner is unveiling a major plan designed to improve public safety at pharmacies throughout the state.

The administration's proposal would require...

(Ray Long and Sam Roe)

Rob Karr, president of the Illinois Retail Merchants Association, which includes small independent pharmacies and major chains, said his group will be "pursuing active opposition." He said that reforms Rauner rolled out following the Tribune investigation are among actions that already should enhance safety at pharmacies.

The Republican governor proposed requiring pharmacists to give counseling when a person buys a medication for the first time or when prescriptions change. He also plans to deploy "mystery shoppers" to check how well pharmacies follow Illinois standards, beef up inspector oversight of drug interaction issues and form a task force to establish safety measures when consumers get multiple prescriptions and use various doctors and pharmacies.

Rauner told the Tribune he wanted to study specifics before weighing in on Flowers' proposals, but he worried that limits on pharmacist hours and other restrictions could "raise up costs and don't really increase safety." Still, Rauner spokesman Lance Trover said the governor is open to reviewing the Flowers bill as it moves forward this spring.

Pharmacies miss half of dangerous drug combinations Sam Roe, Ray Long and Karisa King

The Tribune reporter walked into an Evanston CVS pharmacy carrying two prescriptions: one for a common antibiotic, the other for a popular anti-cholesterol drug.

Taken alone, these two drugs, clarithromycin and simvastatin, are relatively safe. But taken together they can cause a severe breakdown...

The Tribune reporter walked into an Evanston CVS pharmacy carrying two prescriptions: one for a common antibiotic, the other for a popular anti-cholesterol drug.

Taken alone, these two drugs, clarithromycin and simvastatin, are relatively safe. But taken together they can cause a severe breakdown...

(Sam Roe, Ray Long and Karisa King)

Flowers put the final touches on her proposal during a summit at her South Side office on 79th Street late last month with officials from Teamsters Local 727, which represents 130 CVS and 550 Osco pharmacists in the Chicago area, and the National Pharmacists Association-United Steelworkers Local 1969, which represents about 1,050 Walgreens pharmacists in the Chicago region.

She insisted that whistleblower protections be part of the bill because pharmacists should be free to speak up if a drugstore's practices put patients in jeopardy.

"They have to add whistleblower because right now they're all afraid to speak," Flowers said, saying the pharmacists face an "amazing" fear of retaliation.

"Whistleblower protection would protect the public as well as the employee," Flowers said.

The bill primarily focuses on workplace issues that pharmacists believe can lead to mistakes. Interviews and studies point to an emphasis on speed as one explanation why so many pharmacies failed the Tribune tests.

The Tribune's investigation, published in December, found that pharmacists frequently race through legally required drug safety reviews — or skip them altogether. According to Illinois law, pharmacies are required to conduct several safety checks, including whether the dose is reasonable and whether the medication might interact with other drugs the patient is taking. But in the Tribune tests, pharmacies rarely asked what other medications testers were using.

Pharmacists also told the Tribune that they felt overwhelmed by pressures at the workplace to work quickly and meet quotas.

Under the proposal, pharmacists would be limited to an eight-hour workday, a provision that Flowers said would likely be adjusted to address extenuating circumstances. The bill calls for a minimum of two 15-minute rest breaks and one 30-minute meal period within one workday of at least seven hours.

The bill also would place a ban on activities that can distract pharmacists from their drug-safety duties, such as promotional requirements and productivity quotas. Flowers said she's seeking to keep pharmacists focused on ensuring prescriptions are filled correctly rather than having to meet quotas, give flu shots and juggle other issues.

Chuck Zuraitis, head pharmacist at south suburban Park Forest CVS and a Teamsters union steward, said rules on hours, break times and other provisions are necessary because pharmacists have a growing number of responsibilities.

"You have so many things, and you're so distracted, and you need a break mentally," Zuraitis said. "It's hard to focus if you're working for 10, 12, 14 hours."

Garth Reynolds, the executive director of the Illinois Pharmacists Association, immediately came out against the overall legislation, saying provisions like a limit of 10 prescriptions per hour for one pharmacist "don't make sense." The association represents pharmacists and independent pharmacy owners.

"You could have one patient come in from the hospital who is discharged with 10 prescriptions," Reynolds said. "What are you going to do the rest of the hour while you have patients waiting for care?"

Flowers acknowledged there may be problems with such a strict limit, saying that she's open to fixing that with an amendment later in the process.

Reynolds said he recognized pharmacists face workflow issues that need to be addressed, but he said the one-size-fits-all approach in the Flowers proposal "is not the solution."

Flowers said she expects negotiations on the legislation but called her proposal is a "good starting point."

Rep. Lou Lang, a Skokie Democrat on the leadership team of House Speaker Michael Madigan, D-Chicago, said it is "premature" to judge the ultimate position of the speaker or the rest of the caucus because the wide-ranging bill just landed in the legislative hopper.

Lang supports the concept of making sure pharmacists are well-trained, get their rest and fill prescriptions properly, but he said the details of the bill first need to be vetted and analyzed.

CVS, the nation's largest pharmacy retailer by store count, had no comment regarding Flowers' bill. The company had the highest failure rate of any chain in the Tribune tests, dispensing the medications with no warning 63 percent of the time. Walgreens, which had the lowest failure rate at 30 percent, also did not comment.

States throughout the country vary on regulations over pharmacist working hours, ranging from having a requirement for meal or rest breaks during a full day to limiting a single shift to 12 hours.

In a move squarely aimed at reducing medication errors, Minnesota is on the verge of approving a new rule to give break time in pharmacies because people "have a breaking point," said Cody Wiberg, executive director of the state's board of pharmacy.

The rule, expected to take effect July 1, would allow for a 30-minute, uninterrupted meal break for pharmacists, technicians and interns working over six straight hours and bar shifts of more than 12 consecutive hours. A worker would be allowed to use the nearest washroom within each four-hour period.

Pharmacists complained they faced such heavy workloads that they didn't get time to eat or go to the rest room, leaving them lightheaded and avoiding liquids, Wiberg said.

"They would deliberately not drink fluids," he said. "Throughout the day, they'd cut the intake of fluids."

By the end of a long shift, Wiberg said, "you're probably not going to be at the top of your game."

Rlong@chicagotribune.com

sroe@chicagotribune.com

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