From a lack of control over narcotics to expired drugs on the shelves, inspectors at the Ohio Board of Pharmacy have found more problems at what appear to be chronically understaffed CVS pharmacies.

The new inspection reports from four Ohio pharmacies are in addition to reports finding similar problems at nine others that the Capital Journal reported on in July. In those reports, inspectors described mass departures by frustrated, burnt-out employees who said they didn’t think they could do their jobs safely and didn’t feel supported by CVS management.

Several current and former CVS pharmacy employees made similar complaints to the Capital Journal and said that the corporation seemed to be more focused on maintaining profits than it was on protecting patients.

For its part, CVS maintains that it strives to uphold the highest standards of patient service and safety. 

“As we’ve previously stated, we’re working with the Board of Pharmacy to resolve allegations raised from prior inspections at select CVS Pharmacy locations, we have policies and procedures in place to support prescription safety, and we’re committed to ensuring there are appropriate levels of staffing and resources at our pharmacies,” spokeswoman Amy Thibault said in an email Friday.

But the pharmacy board seems skeptical. 

Earlier this month, it proposed sweeping new rules that were prompted in part by what it found in its inspections of Ohio CVS stores. An important one is aimed at limiting wait times for prescriptions to be filled to 72 hours after inspection reports found numerous 14-day waits and some that were as long as a month.

One of the newly released inspection reports details the unexplained loss last year of nearly 1,000 doses of controlled substances at CVS store No. 16660 in Rossford, a Toledo suburb. They include 499 doses of Alprazolam, also known as Xanax, and 275 doses of Hydrocodone and Oxycodone.

The report said that the loss of 413 Alprazolam tablets was discovered on Nov. 12, 2021, but not reported until Jan. 4, 2022, nearly two months later.

On April 14, an inspector spoke to CVS’s asset protection leader about the losses. That person said they “were due to operational error at the pharmacy. He did not know why the losses were reported months after discovery. He reported the losses to CVS’ regulatory office and the office later reported to the Board,” the report said.

CVS, which owns the largest pharmacy retail chain in the United States, has been accused of using other business units to cut drug reimbursements in order to drive smaller competitors to sell out to CVS. Regardless of whether that’s actually the case, CVS for the past five years has been buying up and closing its competitors and moving prescriptions at those pharmacies to existing CVS stores.

In 2021, CVS also announced that it would also close 900 of its own stores in the United States over the next three years and move those prescriptions to remaining CVS locations as well.

But as it has heaped loads of new work onto its remaining pharmacies, it’s unclear whether it’s added staffing to help deal with the extra work.

A Board of Pharmacy report dated Aug. 16 said that Store No. 6153 in Columbus “absorbed prescriptions from CVS No. 342 which closed in August 2022.”

It added that the consolidation increased the prescription workload by at least 63%.

“The pharmacy went from filling 2,500 to 2,700 prescriptions per week to filling 4,400 prescriptions the week ending October 15, 2022,” it said.

A Dec. 8, 2022 inspection found conditions consistent with understaffing. 

• “Drug shelves were dusty, cluttered, and overflowing.”
• “Pharmacy aisles were lined with stock bottles and trash (prescription inserts, foils, bits of paper, and loose pills).”
• “There were 1,372 prescriptions in the work queue. The pharmacy dispenses an average of 700 prescriptions per day. The pharmacy was five days behind in the work queue.”

Thibault, the CVS spokeswoman, didn’t answer directly when asked whether the store added staff after it absorbed 63% more prescriptions from store No. 342. Similarly, the company’s spokespeople wouldn’t respond directly to earlier employee claims that they’re frequently told to cut hours even when employees are available and that district and regional managers receive bonuses based in part on keeping down labor costs.

Another of the reports released last week indicates similar cluttered, dirty conditions that could be related to understaffing — this time at CVS store No. 6183 in Springfield. It also underscored how high turnover that is often associated with understaffing can lead to the lack of controls over dangerous drugs.

During an inspection on Feb. 1, inspectors found that an inventory of controlled substances hadn’t been conducted since the previous April. That was the case even though there was a change of “Responsible Person,” or head pharmacist, in December and one was required to be done then.

A former CVS pharmacist last month told the Capital Journal that the lack of such controls — along with erratic doublechecks called “cycle counts” — could allow narcotics to disappear from pharmacy shelves in a way that’s impossible to trace.

Yet another inspection report released last week details further problems likely associated with understaffing at CVS store No. 6086 in Lebanon.

On Sept. 29, 2022, inspectors found “multiple expired drugs, including Colesevelam hydrochloride 626mg, armour thyroid 2 grain tablets, quinapril 40mg tablets, and quetiapine 200mg tablets, were in the active drug stock. They had expired between June 1, 2022 and August 30, 2022.”

After a subsequent inspection, they told the pharmacist in charge, “On or about October 20, 2022, you dispensed expired heparin 5000u/mL injections to Patient A.B. Patient A.B. administered one dose of the expired heparin 5000u/mL injection.”

Heparin is a blood thinner and if it’s expired, it can put an unsuspecting patient at risk by being less effective. Even so, a follow-up visit on Nov. 7, 2022 indicated that the problem with expired drugs persisted.

“Multiple expired drugs, including creams and ointments, were in the active drug stock,” the report said. “They had expired between August 2022 and October 2022.”

It’s not only CVS that seems reluctant to staff pharmacies at adequate levels. Opinion polling submitted by the Board of Pharmacy along with its proposed rule changes suggests that it’s a problem among the big chains, with their obsession with profits and relentless cost-cutting.

One was a 2021 survey asking Ohio pharmacists whether they agreed with the statement, “I feel that the workload-to-staff ratio allows me to provide for patients in a safe manner.” 

Almost 90% of those working for large chains responded that they didn’t have enough staff to keep patients safe. By contrast, almost three quarters of small-chain and independent pharmacists said they were adequately staffed to protect patients.