Maine’s biggest pharmacy chain has agreed to pay more than $68,000 in fines this year for violating state staffing and operating hours laws at 10 locations, an apparent sign of continued labor shortages in the healthcare industry tied to the coronavirus pandemic.
Walgreens has been fined 15 times in 2022 by the Maine Board of Pharmacy for either failing to have a pharmacist in charge — a position responsible for ensuring the pharmacy complies with state law — or reducing its operating hours without notice, according to state records. The chain with the next-highest number of penalties was CVS, with four cases and $13,500 in fines.
For some customers, the closures meant being unable to access crucial medication, or receiving less than what they required, according to board records obtained through a Freedom of Access Act request. One pharmacist quit covering a second location because they were worried about the quality of care they could provide.
Walgreens is the most prominent chain pharmacy in Maine with 70 locations, according to its website. In comparison, Hannaford has 58 pharmacies, CVS has 26 locations and Walmart has 12 pharmacies in the state.
“I think every chain out there is struggling,” said Joe Bruno, the CEO of Community Pharmacies and a former pharmacy board member. “[Pharmacy] is a very stressful job right now.”
That is because the job is more difficult than ever, Bruno said. Pharmacists have to handle more vaccines and booster shots as the pandemic continues, in addition to a need for more prescriptions. The industry is also having a difficult time hiring technicians to help out, which means a pharmacist may often face a full day largely alone, handling both incoming customers and those in a drive through.
Bruno said his stores have a full staff, but knows hiring is difficult right now. It is not uncommon to see pharmacies closing for lunch or Sundays now to limit the strain on staff, he said.
The Walgreens issue came to the attention of the board at the end of last year, according to WGME. Then, the company cited workforce shortage challenges that are affecting much of the health care industry in several cases and its efforts to move pharmacists around to provide sufficient coverage.
Walgreens spokesperson Kris Lathan said Thursday that the company has adjusted its hours in Maine to try to disrupt patient care as little as possible. She said they attempt to direct people to other Walgreens when possible and advised people to check the company’s store locator for hours.
State records show inspectors found violations at 10 locations spanning from Wells to Lewiston, beginning last year and continuing through this summer. Consent agreements were agreed to for each of them, with fines ranging from $500 to $18,000.
Many of the cases focus on a requirement that the pharmacies remain open a minimum of 40 hours a week. Others highlight a requirement that they have a pharmacist in charge.
Board members referred a reporter to the department of regulation for comment. Joan Cohen, the deputy to the commissioner of that department, said she could not comment on what was causing the staffing problems.
The steepest penalty in recent months was levied against the company’s Auburn store, which at one point was only open for 16 hours during a week in mid December, according to a consent agreement.
The store had experienced a fire in November but had failed to seek a waiver to operate for less than the required 40 hours a week, the board said. Walgreens responded that it had reported closures and, in one instance, was denied a waiver to reduce hours in April.
Ultimately, the store was open for less than 40 hours for 18 weeks between October 2021 to April 2022. That resulted in an $18,000 fine.
In another case, an Old Orchard location operated for seven weeks without a pharmacist in charge after Walgreens failed to request ahead of time that its incoming pharmacist for that branch be allowed to head two locations. That pharmacist left their prior store completely eventually and was allowed to operate at the Old Orchard branch, but that store had been without a head pharmacist in the interim for seven weeks. That resulted in a $7,000 fine.
The Old Orchard Beach location was without a pharmacist in charge after the previous employee refused to continue to split their time at two locations, according to emails included in the investigation.
That pharmacist was clearly concerned that the split duties were affecting her ability to provide adequate care for the patients. She said on March 4 she would continue to head only the Saco store. Walgreens asked if another pharmacist could lead the Old Orchard Beach location three days later.
“I can’t continue to put my license on the line to keep patients safe when Walgreen Eastern Co. can’t keep the store open,” she wrote to the licensing board. “I am getting complaints and I don’t even work in that store. I was trying to do the right thing for our patients.”
For one patient in Windham, that store’s frequent closures in January presented a “life-threatening” situation for their wife because they could not access certain medications. Attempts to contact the store or transfer the prescription to another pharmacy were unsuccessful because the phone system would not allow the transfer and they could not get in touch with someone to help them, they wrote.
“I am now seriously concerned for my wife’s help, and our next stop may be the pharmacy at the ER,” the person, whose name was redacted under state confidentiality laws.
Walgreens area health care supervisor KaBrina Hudson responded to the complaint in March, saying insufficient staffing was affecting their ability to keep the pharmacy open regularly. She noted the company was adjusting operating hours for 64 locations across the state to provide more consistent hours. She later said Walgreens had to close several pharmacies on weekends, according to documents released under the public records request.
Walgreens is facing similar problems in other parts of New England: the Vermont licensing board is pursuing legal action against Walgreens after it fielded 70 complaints related to insufficient staff, unannounced store closures and losing track of controlled substances, the VTDigger reported earlier this year. Staffing issues also caused stores to close suddenly in Cambridge earlier this year.
The company is advertising for 16 pharmacists right now in Maine, according to job postings on its website. A pay transparency site run by the company says the position pays between $52 to $74.80 per hour, depending on geography, experience, education and skills, and offers a sign-on bonus. The number is not listed on the company’s official job website, but the Wall Street Journal reported in August that the bonuses could go up to $75,000.
Walgreens announced in October that it would eliminate “task-based metrics” from its performance reviews as a way to improve the workplace environment, Axios reported. Brad Ulrich, the group vice president of pharmacy operations and the person who signed off on Walgreens’ consent agreements, told Axios it is part of an effort to elevate the pharmacist role as the company looks to provide new services.
Even with the complaints resolved, the problem of trying to keep pharmacies staffed is likely to continue. Data collected by the American Association of Colleges of Pharmacy shows that pharmacy degrees have been steadily dropping since the 2015-2016 school year after increasing steadily since 1990. The Albany College of Pharmacy and Health Sciences closed its satellite Vermont campus in June 2021, leaving the state without a pharmacy college.
Emily Dornblaser, the interim dean of the University of New England College of Pharmacy, said that trend is reflected in the school’s own graduation rates: 35 students will graduate from the program this year, compared to the 100 or so students when the program first launched in 2013, she said.
The workforce problem for the industry can be traced back to the 2008 financial crisis, Dornblaser said. Then, many older pharmacists who might have retired ended staying, meaning the market became saturated. Chains started outsourcing some work to technicians, who are cheaper, and many pharmacists often covered shifts by themselves.
But there is also a cultural element, Dornblaser said. Pharmacists want to connect with people, but many corporations evaluate their performance based on how quickly they can fill prescriptions and move customers through, which makes the service experience much more transactional.
The pandemic, in a way, reversed that trend, because pharmacists can also do some medical evaluations to determine if people need more care, Dornblaser said. But the increased pressure of being one of the few medical locations still readily accessible during the pandemic, combined with even more workforce shortages as people got sick with COVID-19, created a burnout situation the health care industry has yet to fix.
The trend could change if people come to expect slower, more thoughtful service that allows pharmacists to reconnect with people and to prioritize safety, Dornblaser said.
“Working in community pharmacies needs to get back to being about patient care,” she said. “We need to change what being a pharmacist is all about and what they can do for you.”
Update: This story has been updated to include a response from Walgreens that was sent Thursday morning, and to correct the number of Hannaford pharmacies in Maine.
Caitlin Andrews covers state government and general assignment stories for The Maine Monitor. Reach her with other story ideas by email: firstname.lastname@example.org.