Nine Walgreens pharmacies in Iowa hit with fines, licensing sanctions

State licensing officials have sanctioned pharmacies in nine of Iowa’s Walgreens stores for a variety of alleged violations, including missing narcotics, a lack of qualified personnel and issues that caused some Iowans to lose access to their medications.

Two of the nine stores were sanctioned earlier this year for their hiring practices.

The store hit with the most serious penalties is the Walgreens pharmacy located at 1251 Fourth St. SW in Mason City. The Iowa Board of Pharmacy charged with the store with six separate regulatory violations: practicing in a manner that is harmful to the public; failure to employ an adequate number of qualified personnel; failure to ensure that the perpetual inventory record for all Schedule II controlled substances is accurate and matches the actual on-hand inventory; failure to transfer prescriptions to another pharmacy upon the request of a patient; failure to adhere to regulations pertaining to a change in status of the pharmacist in charge; and failure to create and maintain complete and accurate records.

According to the board, the Mason City pharmacy underwent an inspection in December 2021 in response to a complaint received by the board. During the inspection, the board’s compliance officer observed inadequate staffing and noted that the store experienced a high level of staff turnover.

The compliance officer also noted that after three different Schedule II controlled substances were counted, the tallies for all three showed discrepancies between the written, perpetual inventory count and the actual on-hand inventory of those drugs.

In addition, the store’s permanent pharmacist in charge had vacated that position in March 2021, but the board did not receive notification of the temporary person in charge who was appointed, and the board did not receive an application naming a new permanent pharmacist in charge until late December of that year.

Also, during the week of Jan. 17, 2022, the Mason City store was intermittently closed during regular business hours due to the lack of pharmacist coverage. When the pharmacy was able to find coverage and reopened to the public, the pharmacists on staff were unable to transfer prescriptions elsewhere when patients asked them to do so. As a result, some patients were unable to access their medications.

The board has placed the Mason City store’s license on probation for 18 months and imposed a $20,000 civil penalty, although payment of $10,000 of that penalty will be stayed depending on compliance with other conditions established by the board.

In addition, if the store’s pharmacy is unable to be open during normal business hours due to a lack of adequate staffing, it must notify patients and prescribers of the closure in a timely manner, both through signage and a recorded message that provide a telephone number that patients can pass on to another pharmacy of their choosing, allowing the other pharmacy to directly call and request the transfer of prescriptions.

West Des Moines store fined $4,500

In addition to the charges levied against the Mason City store, the board also charged the Walgreens store at 1999 Grand Ave. in West Des Moines with violating state rules requiring pharmacies to employ and place in charge a professionally competent, legally qualified pharmacist; rules that pertain to changes in the status of the pharmacist in charge; and rules that require pharmacies to perform an accurate inventory of all controlled substances immediately after terminating a pharmacist in charge.

Specifically, the board stated the store’s pharmacist in charge vacated the position on Sept. 7, 2021, and the store operated without a temporary or permanent pharmacist in charge for seven weeks, until Oct. 28, 2021.

In addition, the store allegedly failed to submit to the board an application identifying the new permanent pharmacist in charge until Nov. 9, 2021. That application was reportedly incomplete, and the store then failed to promptly respond to board requests for additional information, the board alleged.

Also, the store was accused of failing to complete a controlled-substances inventory until Nov. 4, 2021, almost two months after the previous pharmacist in charge had been terminated.

The store denied the allegations but agreed to a settlement that entails a $4,500 civil penalty.

Other stores face $10,000 penalties

At its August meeting, the board also imposed sanctions against seven other Iowa Walgreens stores, most of which faced an identical set of charges and penalties.

The seven stores are located at 15601 Hickman Road in Clive; 12753 University Ave. in Clive; 901 N.  Ankeny Blvd. in Ankeny; 3140 SE 14th St. in Des Moines; 2545 E. Euclid Ave. in Des Moines; 4555 Fleur Drive in Des Moines; and 111 W. Ridgeway Ave. in Waterloo.

The store located at 3140 SE 14th St. in Des Moines faced a set of charges different from the other six. That store was the target of a complaint alleging that patient counseling was not provided to a patient given a new prescription for prednisone. The store’s security video recordings confirmed that counseling was not provided. In September 2021, the store was inspected. At that time, the store’s on-hand count of hydrocodone was short 247 tablets, after which a board compliance officer requested a full audit of all Schedule II controlled substances.

That audit identified a shortage of 44 tablets of oxycodone, and a shortage of 60 capsules of dexmethylphenidate.

The six remaining Walgreens stores were each charged with failing to maintain accountability of controlled substances and records, and with failing to create and maintain complete and accurate records of all controlled substances on hand. According to the board, each of the six pharmacies reported losses of controlled substances to the board in November 2020, which Walgreens attributed to employee theft. The available documents made public by the board do not disclose the full scope of the theft.

The board later asked Walgreen Co. to perform an audit of all controlled substances at the six stores, from June 2019 through June 2021. The audit reports for each of the pharmacies showed “a large number of drug products which were found to have losses or overages,” the board alleged, and Walgreen Co. was unable to definitively determine what led to the loss of so many controlled substances.

According to the board, the audit indicated that many of the inventory quantities that showed zero controlled substances on hand “must have been inaccurately entered at the time of the annual inventory,” although it’s not clear from the board records what that means with regard to actual losses versus inaccurately reported losses.

The license of each of the six pharmacies, as well as the license of the Des Moines store on Southeast 14th Street, have been placed on probation for one year, and each store has been fined $20,000, although only $10,000 of that needs to be paid depending on compliance with other board requirements, with the remaining $10,000 in penalties considered “stayed.”

In addition, all permanent pharmacists and technicians employed at the seven stores must complete two hours of additional education on inventory management and commit to implementing a new inventory management system by the end of October.

Also, any discrepancies between the actual and expected counts of controlled substances shall result in a $500 civil penalty, and delays in implementing the inventory-control system shall result in $1,500 penalties, with both to be drawn from the $10,000 in stayed penalties.

In March, two of the sanctioned Walgreens stores were among three that were penalized by the Iowa Board of Pharmacy for violations related to hiring practices.

The Walgreens store at 12753 University Ave., Clive, was fined $1,500 for operating for 12 days last spring without a designated pharmacist in charge, and the store at 3140 SE 14th St. in Des Moines was fined $750 for hiring two pharmacy technician trainees who were not registered with the board.

In addition, the store at 3030 University Ave. in Des Moines was fined $1,500 for employing a person to assist a pharmacist with technical work in October 2021, even though the employee would not become a registered pharmacy technician until the following month.