A performance audit of the Arizona State Board of Pharmacy

              STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
A PERFORMANCE AUDIT
OF THE
ARIZONA STATE BOARD OF PHARMACY
AUGUST 1983
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 83- 14
DOUGLAS R. NORTON. CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
August 22, 1983
Members of the Arizona L e g i s l a t u r e
The Honorable Bruce Babbitt, Governor
M r . Joseph J. Rowan, President
Arizona S t a t e Board of Pharmacy
Transmitted herewith is a report of the Auditor General, A Performance
Audit of the Arizona S t a t e Board of Pharmacy. This report is i n response
t o a January 18, 1982, r e s o l u t i o n of the J o i n t L e g i s l a t i v e Oversight
Committee. The performance a u d i t was conducted a s a p a r t of the Sunset
Review s e t f o r t h i n A. R. S. § § 41- 2351 through 41- 2379.
The blue pages present a summary of the report; a response from the
Arizona S t a t e Board of Pharmacy is found on the yellow pages.
My s t a f f and I w i l l be pleased t o discuss or c l a r i f y items i n t h e r e p o r t .
Sincerely,
~ o u ~ f Ra. s N orton
Auditor General
Enclosure
S t a f f : William Thomson
Peter Francis
Stephen Adelstein
Richard Booth
1 1 1 WEST MONROE SUITE 600 PHOENIX. ARIZONA 85003 @ ( 602) 255- 4385
OFFICE OF THE AUDITOR GEhZRAL
A PERFORPIANCE AUDIT OF THE
ARIZONA STATE EOARD OF PHAR? fACY
A REPORT TO THE
ARIZCNA STATE LEGISLATURE
REPORT 83- 14
TABLE OF CONTENTS
SUMMARY
INTRODUCTION AND BACKGROUND
SUNSET FACTORS
FINDING I
Inspection costs can be reduced and efficiency
i m p r o v e d .
T h e B o a r d ' s fee structure can be i m p r o v e d .
CONCLUSION
RECO~ IMENDATIONS
OTHER PERTINENT 1JWORP. IATION
AREAS FOR FURTHER AUDIT WORK
WRITTEN RESPONSE TO THE AUDITOR GENERAL'S REPORT
- Page
i
1
7
13
T h e B o a r d ' s e n f o r c e m e n t effectiveness can be f u r t h e r
i m p r o v e d .
CONCLUSION
FINDING I1
CONCLUSION
RECOmfENDATIONS
FINDING I11
LIST OF TABLES
- Page
TABLE 1 - Licensing and Enforcement A c t i v i t i e s f o r F i s c a l
Years 1979- 80 through 1982- 83 3
TABLE 2 - Revenues and Expenditures f o r F i s c a l Years - 1978- 79 through 1981- 82 and Estimated Revenues
and Budget Data f o r F i s c a l Year 1982- 83 4
TABLE 3 - Inspection Mileage - May 1982 through April 1983 2 5
TABLE4 - C u r r e n t F e e s 33
TABLE 5 - Current Exam and Application Costs 36
The Office of the Auditor General has conducted a performance a u d i t of the
Arizona S t a t e Board of Pharmacy i n response t o a January 18, 1982,
r e s o l u t i o n s f the J o i n t L e g i s l a t i v e Oversight Cornittee. This performance
a u d i t was conducted a s a p a r t of the Sunset review set f o r t h i n Arizona
Revised S t a t u t e s § § 41- 2351 through 41- 2379.
The Arizona T e r r i t o r i a l Board of Pharmacy, which l a t e r became the Arizona
S t a t e Board of Pharmacy, was e s t a b l i s h e d i n 1903. The Board c u r r e n t l y has
seven members appointed by the Governor, two of whom a r e lay members. The
Board l i c e n s e s pharmacists and i n t e r n s , i s s u e s permits t o drug o u t l e t s of
a l l types, inspects permittees, i n v e s t i g a t e s complaints, conducts
d i s c i p l i n a r y proceedings and educates the public and pharmacists on drug
abuse and pharmacy laws. The Board has a full- time s t a f f c o n s i s t i n g of an
executive s e c r e t a r y , f o u r i n s p e c t o r s and four o f f i c e personnel. Board
revenues a r e obtained from f e e s f o r examinations, l i c e n s e s and permits.
Enforcement Effectiveness ( see page 13)
The Board has s i g n i f i c a n t l y improved its enforcement program over t h e past
2- 1/ 2 years. The Board has increased the number of d i s c i p l i n a r y a c t i o n s
taken and has improved complaint i n v e s t i g a t i o n procedures. However,
f u r t h e r progress can be made. The Board can improve complaint
i n v e s t i g a t i o n thoroughness and documentation. In a d d i t i o n , t h e r e is no
requirement t h a t insurance companies report t o the Board information
regarding malpractice insurance claims against pharmacists. F i n a l l y , t h e
Board doesn't r e g u l a r l y disseminate information on the c u r t a i l e d
prescription- writing p r i v i l e g e s of d i s c i p l i n e d medical p r a c t i t i o n e r s t o
pharmacists.
C
To increase the thoroughness of complaint i n v e s t i g a t i o n s , the Board should
interview doctors or i n s p e c t physical evidence when appropriate. A more
thorough review of complaint i n v e s t i g a t i o n s by the chief inspector would
ensure t h a t these s t e p s were taken when necessary. In a d d i t i o n , care
should be taken t o f i l e copies of a l l correspondence and other
documentation i n the appropriate f i l e s .
The insurance code should be amended t o r e q u i r e insurance companies t o
r e p o r t m a l p r a c t i c e i n s u r a n c e claims and s e t t l e m e n t s t o the Board. In
a d d i t i o n , the s t a t u t e s of other h e a l t h Boards whose p r a c t i t i o n e r s w r i t e
p r e s c r i p t i o n s should be amended s i m i l a r l y t o those of the Board of Medical
Examiners t o r e q u i r e d i s c i p l i n a r y a c t i o n t o be reported t o t h e Board. The
Board should then f i n d an acceptable method t o r e g u l a r l y disseminate t h i s
information t o pharmacists.
Inspection Efficiency ( see page 23)
Pharmacy i n s p e c t i o n s can be performed i n a more e f f i c i e n t and l e s s c o s t l y
manner. The chief i n s p e c t o r ' s . time is i n e f f i c i e n t l y u t i l i z e d a s a r e s u l t
of h i s assigned inspection t e r r i t o r y . Inspectors i n a p p r o p r i a t e l y use
24- hour assigned S t a t e motor pool vehicles f o r commuting. Additionally,
t r a v e l claims a r e not always i n compliance with e s t a b l i s h e d Department of
Administration ( DOA) t r a v e l p o l i c i e s .
The chief inspector should be reassigned t o a Phoenix- area inspection
t e r r i t o r y . I n a d d i t i o n , e i t h e r the i n s p e c t o r s ' use of S t a t e vehicles f o r
commuting should be eliminated, or t h e S t a t e should be reimbursed by the
i n s p e c t o r s f o r commuting c o s t s . F i n a l l y , t r a v e l claims should be reviewed
more c l o s e l y f o r compliance with DOA t r a v e l p o l i c i e s .
Fee S t r u c t u r e ( see page 33)
Portions of the Board of Pharmacy's f e e s t r u c t u r e and r e l a t e d procedures
should be changed. The Board's s t a t u t o r y exam f e e s t r u c t u r e i s not based
on c o s t s , and i t r e s u l t s i n some a p p l i c a n t s ' exam fees being subsidized by
o t h e r a p p l i c a n t s . In a d d i t i o n , the Board's grade c e r t i f i c a t i o n f e e i s not
c l e a r l y s p e c i f i e d i n t h e pharmacy s t a t u t e s .
The Board's statutes ( A. R. S. 532- 1924. A.) should be amended to eliminate
the provision for a free second examination and make the examination fee
structure more flexible. In addition, the grade certification fee
currently charged by the Board should be statutorily authorized.
iii
INTRODUCTION AND BACKGROUND
The Office of the Auditor General has conducted a performance a u d i t of the
Arizona S t a t e Board of Pharmacy i n response t o a January 18, 1982,
resolution, of the J o i n t L e g i s l a t i v e Oversight Committee. This performance
a u d i t was conducted a s a p a r t of the Sunset review s e t f o r t h i n Arizona
Revised S t a t u t e s ( A. E. S.) $ 941- 2351 through 41- 2379.
The six- member Arizona T e r r i t o r i a l Board of Pharmacy was e s t a b l i s h e d i n
1903 f o r the purpose of l i c e n s i n g pharmacists. When Arizona became a
s t a t e i n 1912, the Board's t i t l e was changed t o the Arizona S t a t e Board of
Pharmacy.
The Ninth L e g i s l a t u r e ( 1928- 1929) amended the pharmacy laws t o r e q u i r e t h e
r e g i s t r a t i o n of pharmacists. The Board's membership was increased t o
seven pharmacists appointed by the Governor t o four- year terms. In 1935,
the 1 2 t h L e g i s l a t u r e provided f o r new d e f i n i t i o n s and expansion of Board
a u t h o r i t y , and the Board was reduced t o 5 members serving 5- year terms on
a staggered appointment b a s i s . For the f i r s t time, c o l l e g e graduation was
required t o become a pharmacist, whereas previously p r a c t i c a l experience
was considered of g r e a t e r importance.
The pharmacy laws underwent major modifications i n 1951 and 1970. Except
f o r minor changes l e g i s l a t e d over the past 13 y e a r s , t h e 1970 rewrite i s
the current law. In 1976, the Board was again expanded t o seven members,
two of whom a r e l a y members.
Currently, the Board l i c e n s e s pharmacists and pharmacy i n t e r n s . An
applicant must be a graduate of a recognized school of pharmacy and have
1,500 hours of i n t e r n t r a i n i n g before being able t o take the two required
0
exams ( a two- day n a t i o n a l exam sponsored by the National Association of
Boards of Pharmacy and a jurisprudence exam on Arizona pharmacy law).
Upon receiving acceptable exam scores, the applicant is licensed as a
r e g i s t e r e d pharmacist." The Board a l s o i s s u e s permits f o r a l l drug
o u t l e t s ( pharmacies, h o s p i t a l pharmacies, patent and p r o p r i e t a r y outlets*"
and general dealers***), drug wholesalers and drug manufacturers ( see
Table 1 foe- a summary of the Board's l i c e n s i n g and enforcement a c t i v i t i e s
f o r t h e p a s t four years).
In a d d i t i o n t o i t s l i c e n s i n g d u t i e s , the Board inspects permitees,
promulgates r u l e s and r e g u l a t i o n s , i n v e s t i g a t e s complaints, conducts
d i s c i p l i n a r y proceedings and educates pharmacists and the public on drug
abuse and pharmacy laws. The Board's f u l l time s t a f f c o n s i s t s of an
executive s e c r e t a r y , four i n s p e c t o r s ( one of whom is based i n Tucson) and
four o f f i c e personnel.
Revenues a r e obtained from f e e s f o r examinations, l i c e n s e s , permits and
renewals of l i c e n s e s and permits. The percentage of such revenues
deposited i n the S t a t e Board of Pharmacy Fund t o be used f o r the Board's
operations is 90 percent, and 10 percent is deposited i n the S t a t e General
Fund. The Board's revenues and expenditures f o r f i s c a l years 1978- 79
through 1981- 82 and the budget f o r f i s c a l year 1982- 83 a r e shown i n Table
2.
* In 1983, A. R. S. 532- 1922 was changed t o allow f o r e i g n graduates the
opportunity t o be examined.
** Patent and p r o p r i e t a r y ( P & P) o u t l e t s a r e nonpharmacy o u t l e t s t h a t
s e l l only over- the- counter nonprescription drugs. These o u t l e t s a r e
o f t e n part of supermarkets. P & P permits a r e renewed b i e n n i a l l y a t a
f e e of $ 100.
*** General d e a l e r o u t l e t s a r e very limited over- the- counter o u t l e t s .
They can s e l l only those types of nonprescription drugs s p e c i f i e d i n
the Board's r u l e s and r e g u l a t i o n s ( R4- 23- 602 a s authorized by A. R. S.
532- 1930). The general d e a l e r permit is a nonexpiring permit t h a t
c o s t s $ 10. It i s designed f o r very low- volume operations such a s gas
s t a t i o n s t h a t s e l l items such a s a s p i r i n and cough drops f o r the
convenience of the public.
TABLE 1
LICEWSING AND ENFORCEMENT ACTIVITIES FOR FISCAL YEARS
1979- 80 THROUGH 1982- 83
F i s c a l Year F i s c a l Year F i s c a l Year F i s c a l Year
1979- 80 1980- 81 1981- 82 1982- 83
Licenses and Permittees
as of June 30:
Total pharmacists
r e g i s t e r e d 3,774 4,026
Pharmacy i n t e r n s 259 178
Pharmacies ( a l l types) 628 645
Wholesale drug firms 54 61
Manufacturers 14 13
Patent or p r o p r i e t a r y
o u t l e t s 2,442 2,528
General d e a l e r s 864 81 7
A c t i v i t y f o r f i s c a l year:
F u l l a u d i t s of drug
a c c o u n t a b i l i t y
Pharnacy inspections
( including h o s p i t a l s )
Manufacturer inspections
Wholesaler i n s p e c t i o n s
Patent and p r o p r i e t a r y
i n s p e c t i o n s
General d e a l e r i n s p e c t i o n s
Complaints i n v e s t i g a t e d
Hearings held
Informal conferences held
Sources: Board of Pharmacy f i s c a l year 1983- 84 budget request ( hearing and
conference data supplied by Board executive s e c r e t a r y ) .
TABLE 2
REVENUES AND EXPENDITURES FOR FISCAL YEARS 1978- 79 THROUGH 1981- 82
AND ESTIMATED REVEhWES AND BUDGET DATA FOR FISCAL YEAR 1982- 83
* Actual
F i s c a l Year
1978- 79
Number of FTEs 8
Revenues :
Licenses
Fees
Other
Total
Actual Actual Actual
F i s c a l Year F i s c a l Year F i s c a l Year
1979- 80 1980- 81 1981- 82
Estimted
Revenues
and Budget
F i s c a l Year
1982- 83
90 percent credited
t o Pharmacy Fund 318,553 223,648 316,627 280,619 421,110
Additonal revenue - a
100 percent credited
t o Pharmacy Fund ( not
subject t o 90/ 10
provision) *
Total revenue
c r e d i t e d t o
Pharmacy Fund
Expenditures:
Personal s e r v i c e s and
employee- related
expenses
Professional and out-s
i d e s e r v i c e s
Travel -
In- S t a t e
Out- of- State
Other operating
Equipment
Refunds
Total expenditures
Excess of revenues credited d
t o Pharmacy Fund over
expenditures 65,429 ( 57,216) 2,999 ( 65,196) 36,820
Ending fund balance $ 277,786 $ 220,570 $ 223,748 $ 158.280 $ 195,100
Sources: Board of Pharmacy Annual Reports, S t a t e of Arizona Appropriations Reports and ~ o a A
of Pharmacy's f i s c a l year 1983- 84 budget request
* Includes revenue from book and manual s a l e s and grade c e r t i f i c a t i o n fees.
Scope of Audit
Our audit of the Board of Pharmacy addressed issues set forth in the 11
Sunset Factors in A. R. S. 941- 2354. Additional detailed work was conducted
on the following issues:
Whether the Board's enforcement activities are effective and at an
adequate level,
Whether the Board's inspection process is conducted efficiently, and
Whether the Board's fee structure is appropriate.
As part of our review of Board enforcement activities, we examined the
need to keep pharmacists informed about the prescription- writing
privileges of doctors and other practitioners. In addit ion, we conducted
a limited review of four other pertinent issues: 1) Board inspectors'
relationships with the Arizona Pharmacy Association, 2) statutes related
to civil penalties or censure, 3) regulation of patent and proprietary
outlets, and 4) the title of doctor. These four issues are discussed on
pages 39- 42. Areas for future audit work are indicated on page 43.
The Auditor General and staff express appreciation to the members and
staff of the Arizona State Board of Pharmacy for their cooperation and
assistance during the course of our audit.
SUNSET FACTORS
In accordance with A. R. S. $ § 41- 2354, the Legislature should consider the
following 11 factors in determining whether to continue or terminate the
Board of Pharmacy.
1. Objective and purpose in establishing the Board
Although not specifically expressed in State law, the Board's
objective and purpose is to protect the public in relation to the
practice of pharmacy and the manufacturing, wholesaling or supplying
of drugs, devices, poisons or hazardous substances. A. R. S. s32- 1904
establishes the Board's functions as 1) promulgating rules and
regulations, 2) licensing pharmacists and interns, 3) issuing permits
to drug outlets, 4) conducting investigations/ inspections, and
5) taking enforcement/ disciplinary action.
In addition, the Board is striving, in cooperation with other boards
and agencies, to curb forged prescriptions and overprescribing of
controlled substances.
2. The effectiveness with which the Board has met its objective and
purpose and the efficiency with which the Board has operated
The Board has generally met its objective and purpose effectively and
efficiently. The Board has effectively examined and licensed
qualified applicants and registered pharmacies, wholesalers,
manufacturers and over- the- counter drug outlets. The Board's
licensing and registration system has been recently improved with the
introduction of word processing equip~ ent.
The Board's inspection policies and procedures are also adequate,
although improvements in inspection efficiency are needed ( see Finding
11, page 23). Complaint investigation procedures appear to
have improved significantly over the past three years, however,
further improvement is still possible ( see Finding I, page 13). In
addition, the Board's disciplinary proceedings have generally been
effective. The number of hearings held and actions taken by the Board
has increased over the past three years.
...
3. The extent to which the Agency has operated within the public interest
The Board's examination, licensing, inspection and enforcement
functions serve the public interest since effective regulation of the
pharmacy profession protects the public from untrained, incompetent or
unscrupulous pharmacists.
4. The extent to which rules and regulations promulgated by the Board are
consistent with the legislative mandate
During the past two years the Board has reviewed and updated its rules
and regulations to ensure consistency with its legislative mandate.
However, the statutory basis for one Board regulation governing grade
certification fees needs to be clarified ( see page 36).
5. The extent to which the Board has encouraged in~ ut from the ~ ublic
before promulgating its rules and regulations and the extent to which
it has informed the public as to its actions and their expected impact
on the public
The Board has notified professional associations and interested
individuals of all meetings where regulations were discussed. All
proposed regulations and regulatory changes are discussed in open
meetings prior to drafting. The Board appears to have complied with
Open Meeting Law requirements. Minutes have been adequately
maintained and notice has been properly given.
6. The extent t o which the Board has been able t o i n v e s t i g a t e and resolve
c o m ~ l a i n t st h a t a r e within its i u r i s d i c t i o n
The Board appears t o be d i l i g e n t i n following up and resolving
complaints. Complaints received by the Board a r e i n v e s t i g a t e d i n a
timely'- manner by a Board inspector. The Board has taken s t r i c t
enforcement a c t i o n on complaints and inspection- related v i o l a t i o n s .
Although i n v e s t i g a t i o n procedures have been strengthened over the past
t h r e e years, some improvement is s t i l l needed ( see page 13).
7. The extent t o which the Attorney General or any o t h e r a p p l i c a b l e
agency of S t a t e Government has t h e a u t h o r i t y t o prosecute a c t i o n s
under enabling l e g i s l a t i o n
A. R. S. $ 32- 1996 e s t a b l i s h e s criminal p e n a l t i e s f o r v i o l a t i o n of the
pharmacy s t a t u t e s . The following offenses a r e s p e c i f i e d :
Violation of any provision of pharmacy s t a t u t e s ( chapter 18)
without i n t e n t t o defraud or mislead and not involving
c o u n t e r f e i t drugs-- Class 2 misdemeanor ( with i n t e n t t o defraud o r
mislead-- Class 5 felony);
Violation of $ 32- 1965.4 involving manufacture, s a l e or holding
f o r s a l e a c o u n t e r f e i t drug or forgery or misrepresentation of
any drug i d e n t i f i c a t i o n device-- Class 2 felony; and
a Obtaining a l i c e n s e by misrepresentation or f r a u d u l e n t l y
representing oneself a s a pharmacist-- Class 2 misdemeanor.
Violations may be prosecuted by the Attorney General or by a county
a t t o r n e y .
8. The e x t e n t t o which the Board has addressed d e f i c i e n c i e s i n the
enabling s t a t u t e s which prevent it from f u l f i l l i n g its s t a t u t o r y
mandate
The Board has generally addressed d e f i c i e n c i e s i n its enabling
s t a t u t e s . During t h e p a s t two years the Board has proposed or
supported several s t a t u t o r y changes. Recent s t a t u t o r y enactments or
amendments include 1) t h e a d d i t i o n of c i v i l p e n a l t i e s t o A. R. S.
932- 1927, 2) the requirement f o r continuing education, 3) the
requirement of a code i d e n t i f y i n g t h e drug and manufacturer on a l l
legend drug products, 4) the enactment of the Uniform Controlled
Substances Act, and 5) the enactment of i m i t a t i o n c o n t r o l l e d
substances l e g i s l a t i o n ( 1982 HB 2052). Other 1983 l e g i s l a t i o n t h a t
the Board supported includes 1) SB 1256 concerning c l i n i c a l pharmacist
p r a c t i t i o n e r s , 2) HB 2159 concerning look- alike drugs, and 3) HB 2187
concerning q u a l i f i c a t i o n s f o r pharmacist r e g i s t r a t i o n .
9. The e x t e n t t o which changes a r e necessary i n the laws of t h e Board t o
adequately comply with t h e f a c t o r s l i s t e d i n the Sunset law
Additional changes a r e needed i n the Board s t a t u t e s . The l e g i s l a t u r e
should consider:
Amending the insurance code to r e q u i r e r e p o r t i n g of malpractice
claims and s e t t l e m e n t s t o the Board ( see page 17),
Amending A. R. S. s32- 1924 t o make the Board's exam f e e s t r u c t u r e
more f l e x i b l e and f a i r t o a l l a p p l i c a n t s ( s e e page 33), and
Enacting s t a t u t o r y a u t h o r i z a t i o n f o r the grade c e r t i f i c a t i o n f e e
c u r r e n t l y charged by the Board ( see page 36).
In a d d i t i o n , the L e g i s l a t i v e Council has recommended t h a t the
L e g i s l a t u r e consider amending A. R. S. $ 31- 1928. A. t o conform with
A. R. S. $ 32- 1927. B. with regard t o c i v i l p e n a l t i e s and censure ( see
page 41).
F i n a l l y , the Board s u p p o r t s a n increase i n f e e s t o cover higher
operating c o s t s .
10. The extent t o which termination of the Board would s i g n i f i c a n t l v harm
the public h e a l t h , s a f e t y or welfare
The termination of the Board would s i g n i f i c a n t l y harm the public
h e a l t h , s a f e t y and welfare. The p r a c t i c e of pharmacy has the
p o t e n t i a l f o r harm, as evidenced by the Board's complaint f i l e s and
the generally acknowledged danger t h a t drugs can pose. The Board's
l i c e n s i n g and enforcement a c t i v i t i e s a r e e s s e n t i a l t o assure t h a t
pharmacists a r e q u a l i f i e d , competent and e t h i c a l .
11. The extent t o which t h e l e v e l of r e g u l a t i o n exercised by the Board is
appropriate and whether l e s s o r more s t r i n g e n t l e v e l s of r e g u l a t i o n
would be a ~ ~ r o ~ r i a t e
The l e v e l of r e g u l a t i o n exercised by the Board appears t o be
appropriate.
FINEING I
THE BOARD'S ENFORCEPENT EFFECTIVENESS CAN BE FURTHER IMPROVED.
The Board's:!- enforcement procedures could be improved to further reduce the
potential for public harm. The Board has made a considerable effort to
protect the public over the past 2- 112 years. Additional improvements are
needed, however, in the area of complaint investigation thoroughness and
documentation. In addition, insurance companies are not required to
report malpractice claims and settlements to the Board. Finally, an
effective means for disseminating information on disciplined medical
practitioners needs to be established.
Board Effort to Protect the Public
The Board is making a commendable effort in the area of public
protection. The Board's record of disciplinary actions has improved
considerably over the past 2- 112 years. Although documentation of
I) investigative actions has also improved and complaints are being resolved
in a timely manner, the Board realizes the need for further improvement in
complaint investigations.
The Board's record of disciplinary actions has significantly improved over
the past 2- 1/ 2 years. For example from July 1980 through February 1983,
the Board revoked 13 licenses and permits, suspended 16 licenses and put 3
licensees on probation. In comparison, from July 1978 through June 1980,
the Board revoked only 1 license, suspended 8, and placed 2 licensees on
probation.
Complaint investigation procedures and documentation have also improved
over the past 2- 1/ 2 years, and complaints are handled in a timely manner.
Complaint reports from the past 2- 112 years were found to be better
documented and maintained than reports from an earlier period. In
addition, the Board acts on the premise that complaints often identify
problem practitioners, therefore complaint investigations often result in
follow- up inspections and disciplinary proceedings. Although inspections
constitute the bulk of the Board's enforcement activities, complaints are
given a higher priority. Generally complaints are investigated within one
or two days of being received and are resolved in a timely manner.
Seventy- four complaints were investigated in fiscal year 1980- 81 and
fifty- seven in 1981- 82.
The Board's executive secretary is responsible for much of the Board's
improvement in enforcement effectiveness. After assuming office, he
initiated efforts to implement procedures to expedite complaint
resolution.
Complaint Investigation Adequacy
Although significant improvements have been made, complaint investigations
are not always thorough and adequately documented. The Board's existing
complaint investigation procedures do not ensure the thoroughness of all
investigations. In addition, the documentation in complaint reports is
sometimes incomplete.
Current Procedures - The Board's current complaint investigation
procedures include the following nine steps: 1) transfer information
received onto the complaint form, 2) assign an inspector, 3) personally
contact the complainant, 4) visit the pharmacy and talk to the pharmacist
involved, 5) complete the investigation and file the report with the chief
inspector, 6) send the report to the Board review officer,* 7) send the
review officer's recommendations** to the chief inspector for his
* A Board member acts as the Board review officer. Board members
( excluding lay members) are rotated into this position on a 90- day
cycle. ** Possible recommendations which could be made by the review officer
include: no further action, sending a letter to the pharmacist,
calling the pharmacist into a hearing or informal conference,
requiring a follow- up inspection of the pharmacy or taking legal
action.
implementation, 8) correspond with the complainant and pharmacist
involved, and 9) f i l e a l l forms and correspondence i n the appropriate
f i l e s .
Thoroughness Can Be Improved - Some a d d i t i o n a l complaint procedures need
t o be added t o improve the thoroughness of i n v e s t i g a t i o n s . The Board's
current procedures should be supplemented with the following additions.
1. Board i n s p e c t o r s should, when necessary, v i s i t or c o n t a c t t h e doctor
who was responsible f o r writing the p r e s c r i p t i o n involved. The
following case example demonstrates the need f o r personal c o n t a c t w i t h
the responsible doctor.
Case I
A complaint was made a g a i n s t a pharmacist f o r i n c o r r e c t d i r e c t i o n s on
a p r e s c r i p t i o n l a b e l . The l a b e l should have indicated one t a b l e t
twice d a i l y , but instead it read two t a b l e t s twice d a i l y . The doctor
c a l l e d the p r e s c r i p t i o n i n by telephone. The pharmacist involved
maintained t h a t the doctor was unsure of t h e q u a n t i t y t o prescribe.
An a u t h o r i t a t i v e source " Facts and Comparisons," indicated t h e l a b e l e d
dosage was double the usual dose f o r the i n i t i a l day of therapy but
w i t h i n t h e d a i l y dose f o r children under 12. However, d e s p i t e t h e
dosage being t e c h n i c a l l y s a f e , t h e p a t i e n t was unable t o stand a f t e r
the second dose. The Board inspector determined t h a t the p r e s c r i p t i o n
was f i l l e d and labeled c o r r e c t l y . However, the doctor was never
contacted t o determine i f the l a b e l d i r e c t i o n s were per h i s
i n s t r u c t i o n s . The Board sent the pharmacist i n q u e s t i o n a l e t t e r
i n d i c a t i n g t h a t he acted c o r r e c t l y .
2. Complaint procedures should include v e r i f i c a t i o n of physical
evidence. The inspector should personally inspect a l l physical
evidence involved i n a complaint, including p r e s c r i p t i o n records,
l a b e l s and drugs. Case I1 i l l u s t r a t e s the need f o r t h i s procedure.
Case I1
A complaint was received involving a n i n c o r r e c t l y f i l l e d p r e s c r i p t i o n
a l l e g i n g t h a t the p i l l s t r e n g t h was four times the prescribed dosage.
The r e s u l t i n g report was inadequate i n t h a t there was no documentation
t h a t phe i n s p e c t o r p h y s i c a l l y v e r i f i e d the a c t u a l contents of the
p r e s c r i p t i o n and no i n d i c a t i o n t h a t t h e prescribing pharmacist was
contacted. In a d d i t i o n , t h e i n s p e c t o r did n o t i n c l u d e h i s conclusion
or d i s p o s i t i o n i n t h e r e p o r t . The only conclusion present i n the
report was t h a t of the supervising pharmacist of the pharmacy involved.
3. Complaint procedures should include a review by the chief inspector of
completed complaint i n v e s t i g a t i o n s . Complaint r e p o r t s need t o be
reviewed f o r completeness and i f necessary should be returned t o the
inspector f o r f u r t h e r follow- up work. Cases I, I1 and I11 show the
need f o r review* and f u r t h e r follow- up work by the Board inspectors.
Case I11
The Board received a telephone complaint concerning an i n c o r r e c t l y
f i l l e d p r e s c r i p t i o n . This complaint was resolved. However, during
the course of the i n v e s t i g a t i o n , the inspector noted two other drugs
t h a t had been i n c o r r e c t l y s u b s t i t u t e d . No o t h e r n o t a t i o n is made
concerning these other two drugs i n the report and no follow- up work
was ever conducted.
~ t The points contained i n Cases I, I1 and I11 i l l u s t r a t e the need for
increased review of complaints by the chief inspector a s a part of h i s
a d m i n i s t r a t i v e d u t i e s as noted i n Finding I1 ( see page 23).
Inadequate Documentation - Complaint report documentation is not always
adequate. Copies of the following documentation a r e sometimes not
included i n the complaint f i l e s :
0 Correspondence with the complainant,
Relevant p r e s c r i p t i o n s o r l a b e l s ,
Correspondence with the pharmacist who is the subject of the
complaint, and
Recommendations from the Board review o f f i c e r and f i n a l
d i s p o s i t i o n of the complaint.
If t h i s information were i n the complaint f i l e s , it would allow Board
personnel t o e a s i l y determine a l l relevant information concerning a
complaint. In a d d i t i o n , copies of complaint r e p o r t s were not always found
i n the appropriate pharmacy o r pharmacist f i l e s . Proper f i l i n g of report
copies i n these f i l e s helps Board personnel determine when multiple
complaints have been received a g a i n s t a p a r t i c u l a r l i c e n s e e or permittee.
Malpractice Insurance Reporting
The Eoard's enforcement e f f e c t i v e n e s s could be improved i f insurance
companies were required t o r e p o r t i n s t a n c e s of malpractice claims and
s e t t l e m e n t s t o the Board. Current s t a t u t e s do not require mandatory
reporting of malpractice insurance claims. Requirements f o r mandatory
reporting of m a l p r a c t i c e i n s u r a n c e claims a r e already i n the s t a t u t e s of
s i x Arizona h e a l t h regulatory boards.
Insurers a r e not c u r r e n t l y required t o report dangerous or incompetent
p r a c t i t i o n e r s t o the Board. Mandatory reporting laws increase a
r e g u l a t i n g board's a b i l i t y t o review and take d i s c i p l i n a r y a c t i o n on cases
of alleged incompetence o r unprofessional behavior. The lack of such
s t a t u t e s i n the Pharmacy P r a c t i c e Act allows the Board t o remain unaware
of problem p r a c t i t i o n e r s and possible negligence. An example i l l u s t r a t e s
t h i s p o s s i b i l i t y :
A customer sued a pharmacy a l l e g i n g t h a t l a b e l s on two p r e s c r i p t i o n s
were reversed. As a r e s u l t the customer had t o be admitted t o a
h o s p i t a l . The Board's a t t e n t i o n was drawn t o t h i s problem when
a t t o r n e y s involved i n the case c a l l e d the Board f o r information. The
executive s e c r e t a r y is p o s i t i v e t h a t the Board would not have become
aware . of t h i s s i t u a t i o n had the attorneys not contacted the Board.
The Board is c u r r e n t l y considering the need f o r d i s c i p l i n a r y a c t i o n .
L e g i s l a t i o n requiring mandatory reporting of malpractice insurance claims
is already i n the s t a t u t e s of s i x Arizona h e a l t h regulatory boards: Board
of Medical Examiners ( A. R. S. $ 32- 1451.02), Board of Dental Examiners
( A. R. S. $ 32- 1263.03), Board of Chiropractic Examiners ( A. R. S. $ 32- 930),
Board of Optometry ( A. R. S. s32- 1745), Board of Podiatry Examiners ( A. R. S.
$ 32- 852.02) and Osteopathic Board of R e g i s t r a t i o n and Examination i n
Medicine and Surgery ( A. R. S. $ 1855.02). In comparison, the Board of
Pharmacy's impact on public h e a l t h and s a f e t y i s a t l e a s t equal t o these
boards. An incompetent o r negligent pharmacist could harm the public j u s t
as s e r i o u s l y a s a doctor, d e n t i s t or chiropractor.
I f such a reporting requirement is considered f o r the Board of Pharmacy,
the requirement should be placed i n the insurance s t a t u t e s r a t h e r than the
Board s t a t u t e s . Previous performance a u d i t s have repeatedly found t h a t
l i c e n s i n g boards have d i f f i c u l t y i n obtaining compliance by i n s u r e r s with
malpractice reporting requirements. In Report No. 81- 19, A Performance
Audit of the Board of Podiatry Examiners, we addressed t h i s i s s u e and
noted:
" A possible s o l u t i o n t o the f a i l u r e of insurance
companies t o report malpractice data would be t o make
such p r a c t i c e s a v i o l a t i o n of the insurance
code-- possibly with a f i n e or other penalty f o r
noncompliance. The Department of Insurance could then
monitor and enforce the r e p o r t i n g p r o v i s i o n s through its
market conduct examinations and o t h e r r e g u l a t o r y
programs. Further, under t h i s system i f nonreporting was
found, a c t i o n could be taken by the Department of
Insurance, which is involved i n t h e d a i l y r e g u l a t i o n of
insurance companies. . . ."
Relay of P r a c t i t i o n e r
Information t o Pharmacists
Information on the prescription- writing p r i v i l e g e s of medical doctors and
h e a l t h p r a c t i t i o n e r s d i s c i p l i n e d by other boards is n o t r o u t i n e l y reported
t o p r a c t i c i n g pharmacists. The Board h a s n o t complied with the BOPZX
s t a t u t o r y requirement p e r t a i n i n g t o n o t i f i c a t i o n of r e s t r i c t i o n s on
medical d o c t o r s ' p r e s c r i p t i o n p r i v i l e g e s . In a d d i t i o n , o t h e r h e a l t h
boards need s i m i l a r requirements t o supply pharmacists necessary
information concerning t h e i r d i s c i p l i n e d p r a c t i t i o n e r s .
BOMEX Statutory Requirement - In Report No. 81- 11, A Performance Audit of
the Board of Medical Examiners, we s t a t e d t h a t pharmacists lack awareness
of BOMEX d i s c i p l i n a r y a c t i o n s :
" During the course of the a u d i t , we noted t h a t
pharmacists appeared not t o be aware of d i s c i p l i n a r y
a c t i o n s taken by the Board. As a r e s u l t , some
pharmacists did not know t h a t a physician had been
r e s t r i c t e d from prescribing c e r t a i n c o n t r o l l e d
substances. After a u d i t s t a f f discussed the
information with the Board it contacted the Board of
Pharmacy, which has agreed t o publicize i n i t s
q u a r t e r l y newsletter, sent t o a l l licensed pharmacists,
information regarding those d o c t o r s w i t h r e s t r i c t e d
prescription- writing p r i v i l e g e s .
As a r e s u l t , l e g i s l a t i o n was enacted i n July 1982 t o ensure t h i s
information would be supplied t o pharmacists. A. R. S. § 32- 1451.1. s t a t e s :
" If the board a c t s t o r e s t r i c t any doctor of medicine's
p r e s c r i p t i o n writing p r i v i l e g e s the board s h a l l n o t i f y
the s t a t e board of pharmacy of such r e s t r i c t i o n . The
s t a t e board of pharmacy s h a l l n o t i f y the licensed
pharmacies of t h i s s t a t e of any r e s t r i c t i o n s upon any
doctor of medicine's p r e s c r i p t i o n w r i t i n g p r i v i l e g e s .
The Board Has Not Complied - The Board has not complied with the reporting
requirement since its inception and c u r r e n t l y minimal information
regarding d i s c i p l i n e d medical doctors is being made a v a i l a b l e to
pharmacists. No appropriate means c u r r e n t l y e x i s t s f o r sending the
required information t o pharmacists. In a d d i t i o n , s p e c i f i c information
necessary t o f u l f i l l the s t a t u t o r y requirement is not being supplied by
BOMEX i n a format which f a c i l i t a t e s e f f i c i e n t reporting.
Originally the Board planned t o use its q u a r t e r l y National Association of
Boards of Pharmacy ( NABP) Newsletter. However, the space a l l o t e d the
Board i n the NABP newsletter proved t o be i n s u f f i c i e n t . The executive
s e c r e t a r y is c u r r e n t l y seeking another source t o properly r e p o r t t h e
information.
Information is not being supplied by BOMEX i n a format which f a c i l i t a t e s
e f f i c i e n t r e p o r t i n g . In complying with the s t a t u t o r y requirement, BOMEX
supplies the Board of Pharmacy with q u a r t e r l y minutes and appropriate
BOtfEX orders. According t o the executive s e c r e t a r y of the Board of
Pharmacy, the BOPEX minutes and orders a r e not i n a format t h a t
f a c i l i t a t e s drawing the necessary information. Most information is
a v a i l a b l e , however, it is buried i n the minutes and has t o be extracted by
Board personnel. Further, the address of the d i s c i p l i n e d doctor is not
a v a i l a b l e . This i s needed t o help pharmacists pinpoint which doctors a r e
near t h e i r pharmacies. Further, the minutes and orders a r e sometimes
confusing and need c l a r i f i c a t i o n or i n t e r p r e t a t i o n by BOMEX.*
In order t o comply with the BOMEX s t a t u t o r y requirement, the Board needs
to 1 ) f i n d a n appropriate way t o communicate the proper information t o
pharmacists and 2) e n t e r i n t o an agreement with BOEEX regarding the format
BOMEX w i l l follow when reporting information t o the Board.
* The executive d i r e c t o r of BOMEX would encourage the Board of Pharmacy
t o put BOMEX's phone number on a l l n e w s l e t t e r s and encourage
pharmacists t o c a l l BCMEX i f they have questions concerning medical
doctors.
Similar Requirements Are Necessary for Other Health Regulatory Boards -
Other health regulatory boards need requirements to supply pharmacists
with information concerning their disciplined practitioners. According to
the executive secretary of the Board, reporting disciplinary actions of
medical doctors is a step in the right direction. However, he further
stated that without reporting by other health boards, whose practitioners
also have prescription- writing privileges, the information supplied
pharmacists is incomplete."
Information from other health boards, regarding their disciplined
practitioners, should be furnished to the Board of Pharmacy and made
available to pharmacists. Statutes similar to BOMEX's should be enacted.
The Board, in cooperation with the other boards, should then develop a
format for reporting information.
CONCLUSION
The Board's enforcement effectiveness can be improved. Complaint
investigations can be more thorough and better documented. In addition,
the Board does not currently receive needed information on
pharmacy- related malpractice insurance claims. Finally, pharmacists are
not being properly notified regarding disciplined medical practitioners.
RECOMMENDAT IONS
The Board's enforcement effectiveness can be improved if the following
changes are made:
* Practitioners who may write prescriptions include: licensees of BOMEX
( physicians, ophthalmologists and physician assistants who work under
a physician's supervision), osteopathic physicians, homeopathic
physicians, dentists, podiatrists and veterinarians. In addition,
legislation passed in 1982 provides nurse practitioners limited
prescription- writing privileges-- rules and regulations governing these
privileges are currently under development.
1. The Board should amend its complaint i n v e s t i g a t i o n and r e l a t e d
procedures t o include:
a. Contacting doctors associated with the complaint, i f necessary;
b. I n s p e c t i n g p h y s i c a l evidence; and
c. Conducting a more thorough review of a l l complaint i n v e s t i g a t i o n
reports.
2. The Board should improve r e t e n t i o n and f i l i n g of complaint
documentation by
a. F i l i n g a l l correspondence i n the appropriate f i l e s ,
b. Recording a l l f i n a l d i s p o s i t i o n s i n the complaint f i l e , and
c. Including copies of a l l other appropriate documentary evidence i n
the complaint f i l e s .
3. The Insurance Code should be amended t o require companies writing
malpractice coverage f o r pharmacists t o report malpractice insurance
claims and s e t t l e m e n t s t o the Board.
4. The Board of Pharmacy should a) determine an acceptable format f o r the
reported information i n cooperation with each of t h e o t h e r h e a l t h
boards, including BOMEX, and b) e s t a b l i s h a n acceptable method to
disseminate t h i s information t o pharmacists regularly.
5. S t a t u t e s should be enacted requiring other Arizona h e a l t h boards whose
p r a c t i t i o n e r s w r i t e p r e s c r i p t i o n s t o report d i s c i p l i n a r y actions t o
the Board of Pharmacy.
FINDING I1
INSPECTION COSTS CAN BE REDUCED AND EFFICIENCY IMPROVED.
Pharmacy inspections can be performed i n a more e f f i c i e n t and l e s s c o s t l y
manner. The chief i n s p e c t o r ' s inspection t e r r i t o r y is i n e f f i c i e n t l y
covered. I n s p e c t o r s u s e 24- hour assigned S t a t e motor pool vehicles
i n a p p r o p r i a t e l y f o r commuting. Additionally, t r a v e l claims a r e not always
i n compliance with t h e e s t a b l i s h e d Department of Administration ( DOA)
t r a v e l p o l i c i e s .
The Inspection Process
All pharmacies, manufacturers and drug o u t l e t s i n t h e S t a t e a r e divided
i n t o four inspection t e r r i t o r i e s . Each of t h e t h r e e Board i n s p e c t o r s and
the c h i e f i n s p e c t o r is responsible f o r h i s own t e r r i t o r y . The inspector
based i n Tucson is responsible f o r the Tucson metropolitan area and the
communities i n the s o u t h e a s t c o r n e r of the s t a t e . The remainder of the
s t a t e is divided among the other two i n s p e c t o r s and the chief i n s p e c t o r ,
who a r e based i n Phoenix.
Pharmacies, manufacturers and wholesalers a r e generally inspected once
each year. Over- the- counter o u t l e t s ( i . e . , patent and p r o p r i e t a r y o u t l e t s
and general d e a l e r s ) have a lower p r i o r i t y and a r e inspected a s time
permits. Inspectors check f o r general s a n i t a t i o n , adequacy of the
pharmacist's reference l i b r a r y , outdated drugs, c o r r e c t i o n of previously
noted v i o l a t i o n s o r problems and proper posting of a c u r r e n t l i c e n s e .
Additionally a " mini a u d i t " is performed a s part of each pharmacy
i n s p e c t i o n , t h e n a t u r e of which is p e r i o d i c a l l y changed. Previously, the
" mini audit" involved taking an inventory of t h r e e c o n t r o l l e d substances.
Currently, f i v e recent p r e s c r i p t i o n s a r e reviewed to determine the
adequacy of the paperwork, the l a b e l and the container.
The t h r e e i n s p e c t o r s a r e assigned S t a t e motor pool vehicles f o r t r a v e l i n g
t o inspections. The chief i n s p e c t o r , who has the l i g h t e s t inspection
load, uses h i s personal vehicle.
Inspection T e r r i t o r i e s
The chief i n s p e c t o r ' s widely dispersed inspection t e r r i t o r y is handled
i n e f f i c i e n t l y . The chief inspector spends too much t i m e t r a v e l i n g .
Furthermore, h i s inspection functions r e s u l t i n l e s s time being a v a i l a b l e
f o r h i s a d m i n i s t r a t i v e and supervisory r e s p o n s i b i l i t i e s . Assigning the
chief inspector t o a Phoenix- area t e r r i t o r y would i n c r e a s e e f f i c i e n c y .
Chief Inspector Spends Considerable Time Traveling - The chief inspector
spends too much time t r a v e l i n g . The chief i n s p e c t o r a s s i g n s himself an
inspection t e r r i t o r y which has approximately one- fourth the number of
i n s p e c t i o n s covered by each of the other i n s p e c t o r s . However, the chief
inspector averages almost a s many t r a v e l m i l e s p e r month a s t h e o t h e r
i n s p e c t o r s . As shown i n Table 3, the chief inspector logged 18,905 miles
between May 1982 and April 1983. The other Board i n s p e c t o r s , who each
have approximately 4 times the inspection work load, logged from 17,951 t o
23,515 miles.
The reason the chief inspector l o g s s o many t r a v e l miles is because he
cannot e f f i c i e n t l y cover h i s out- of- town inspection t e r r i t o r y given h i s
other r e s p o n s i b i l i t i e s . He has assigned himself an i n s p e c t i o n a r e a t h a t
includes approximately 50 pharmacies which a r e dispersed over a l a r g e area
of the northern, c e n t r a l and e a s t e r n portions of the S t a t e . This
inspection t e r r i t o r y r e q u i r e s e x t e n s i v e t r a v e l , however, he generally does
not spend more than one day out of town a t a time. A t l e a s t part of the
reason f o r t h i s appears t o be t h a t h i s a d m i n i s t r a t i v e and supervisory
r e s p o n s i b i l i t i e s require him t o be a t the Board o f f i c e r e g u l a r l y . ( These
r e s p o n s i b i l i t i e s a r e enumerated on page 26). Therefore, he often t r a v e l s
g r e a t distances yet has time t o do only a minimal number of inspections.
For example, he made nine* one- day t r i p s t o the ~ l a g s t a f f / N i l l i a m s area
* According t o the Board's executive s e c r e t a r y , 3 of these t r i p s were
not made s o l e l y f o r routine inspection- related purposes. These t r i p s
were made f o r i n v e s t i g a t i o n s done i n cooperation with the Food and
Drug a d m i n i s t r a t i o n or other noninspection- related i n v e s t i g a t i o n s .
between July 1982 and April 1983. Pharmacies a r e generally inspected once
each year, and he i s responsible f o r only 10 pharmacies i n the F l a g s t a f f
a r e a . F l a g s t a f f is over 140 miles from Phoenix. During the same 10- month
period, he made 5 one- day t r i p s t o the Globe/ Miami area where he is
responsible f o r only 6 pharmacies. Although the d i s t a n c e t o t h i s area is
less than 1.00 miles, a distance which may not o r d i n a r i l y warrant staying
overnight, each round t r i p took him roughly 4 hours. Moreover, two of h i s
one- day t r i p s t o Globe/ Miami took place only one day a p a r t on November 2
and 3. On both days he appears t o have had o f f i c e d u t i e s t o perform a s he
l e f t from the Board o f f i c e ( which he does o f t e n ) r a t h e r than from h i s
home. Additionally, according t o h i s d a i l y r e p o r t s , he did only two
pharmacy inspections on November 2 and only one h o s p i t a l on November 3.
Generally, r o u t i n e pharmacy i n s p e c t i o n s were expected t o take 1- 1/ 2 t o 2
hours p r i o r t o 1983. Currently they average only about 30 minutes due t o
less extensive " mini a u d i t s " being performed, a s discussed on page 23.
TABLE 3
INSPECTION MILEAGE -
FLAY 1982 THROUGH APRIL 1983
Chief inspector
Inspector 1
Base and Pharmacies i n Miles Cost t o
Area Covered T e r r i t o r y Traveled Board
Phoenix based 5 1
( statewide a r e a )
Tucson based 191
( southeast area of
S t a t e )
Phoenix based 211
( Phoenix metro
a r e a )
Phoenix based 204
( statewide a r e a )
* These f i g u r e s may be i n f l a t e d because they include commuting mileage,
a s discussed on page 27.
Travel Limits the Chief I n s p e c t o r ' s Administration Time - The chief
i n s p e c t o r ' s i n s p e c t i o n - r e l a t e d f u n c t i o n s r e s u l t i n h i s having l e s s time
a v a i l a b l e f o r a d m i n i s t r a t i v e and supervisory functions.
The chief inspector has numerous a d m i n i s t r a t i v e and supervisory
r e s p o n s i b i l i t i e s . They include:
Supervision of the inspection function, including the review of
a l l inspection r e p o r t s coming from the t h r e e o t h e r inspectors;
Review of a l l complaint r e p o r t s ;
Design and preparation of report forms;
Communications with other h e a l t h regulatory boards when needed;
Assisting the Board's attorney general r e p r e s e n t a t i v e i n
c o l l e c t i o n of f a c t s needed f o r hearings;
Provision of backup t o i n s p e c t o r s i n complaint i n v e s t i g a t i o n s and
i n s p e c t i o n s a s needed;
Preparation and r e v i s i o n of the Arizona jurisprudence exam and
grading of the r e s u l t s ; and
Preparation of the chief i n s p e c t o r ' s r e p o r t on inspection
a c t i v i t i e s f o r p r e s e n t a t i o n a t Board meetings.
As discussed on page 16, the chief inspector apparently needs t o spend
more of h i s time on at l e a s t one of h i s administrative/ supervisory
functions ( i . . , the review of complaint r e p o r t s ) . A reduction of h i s
inspection- related t r a v e l time would help him do t h i s . The chief
inspector could be reassigned to a Phoenix- area inspection t e r r i t o r y ,
allowing h i s current t e r r i t o r y t o be covered more e f f i c i e n t l y by the other
Board inspectors. Because of the t r a v e l time involved, the most e f f i c i e n t
way t o conduct remote i n s p e c t i o n s would be t o have an inspector remain out
of town f o r s e v e r a l n i g h t s t o do a number of i n s p e c t i o n s i n a l o c a l area.
24- Hour Vehicle Assignments
S t a t e motor pool vehicles should not be used r e g u l a r l y by i n s p e c t o r s f o r
commuting. The S t a t e is incurring excessive c o s t s i n t h a t i n s p e c t o r s a r e
being subsidized f o r t h e i r commuting expenses. The Board should
reevaluate its policy of assigning motor pool v e h i c l e s t o i n s p e c t o r s on a
24- hour basfs.
Currently, t h r e e Board i n s p e c t o r s ( two i n Phoenix and one i n Tucson) a r e
assigned S t a t e motor pool vehicles on a 24- hour b a s i s on the grounds t h a t
they generally t r a v e l d i r e c t l y t o inspection s i t e s from t h e i r homes each
morning. The chief inspector is not assigned a S t a t e vehicle because of
h i s l i g h t e r inspection load. The two Phoenix- based i n s p e c t o r s l i v e i n a
community north of Phoenix ( approximately one m i l e from each o t h e r )
approximately 32 miles from the Board o f f i c e and a l s o a considerable
distance from the bulk of t h e i r Phoenix- area inspections.
The S t a t e is e s s e n t i a l l y subsidizing Board i n s p e c t o r s ' commuting c o s t s .
For example, assuming the two Phoenix i n s p e c t o r s make the 64- mile round
t r i p i n t o the Phoenix area* on approximately two- thirds of the work days
per year ( based on an estimate of the Board's o f f i c e manager), t h i s c o s t s
the S t a t e over $ 2,900.** Of t h i s amount, the Board of Pharmacy pays
$ 1,320 a t 7k per mile. Regular commuting c o s t s a r e normally born by the
employee, not the S t a t e .
The Department of Administration's r u l e s and r e g u l a t i o n s s t a t e t h a t
domicile- to- duty t r a v e l is allowable only
* Out of the 415 pharmacies t h a t t h e two Phoenix i n s p e c t o r s a r e
responsible f o r , 355 ( or 85%) a r e i n the Phoenix area. ** Based on the a c t u a l l i f e - t o - d a t e operating c o s t s t o the S t a t e f o r the
two Phoenix vehicles. These c o s t s a r e 17.9d and 12.9k per mile.
" When circumstances make it i m p r a c t i c a l f o r the
employee t o r e t u r n the vehicle t o the motor pool upon
returning from an o f f i c i a l t r i p . . . ."
" When an employee is going t o use a v e h i c l e f o r
o f f i c i a l S t a t e business a f t e r h i s normal working hours
on'the same day o r p r i o r t o h i s normal working hours on
the succeeding day."
The only j u s t i f i c a t i o n f o r domicile- to- duty vehicles i n t h i s case would be
t h e i m p r a c t i c a l i t y of r e t u r n i n g t h e v e h i c l e each night. This would not be
a j u s t i f i c a t i o n , however, f o r the S t a t e paying i n s p e c t o r s ' commuting c o s t s .
Some other departments use even more r e s t r i c t i v e c r i t e r i a f o r the
assignment of 24- hour vehicles. For example, the Department of Public
S a f e t y ' s c r i t e r i a f o r assignment of a S t a t e vehicle on a 24- hour b a s i s
are: 1 ) the requirement f o r continual c a p a b i l i t y t o respond t o emergencies
or 2) the performance of frequent off- duty inspections. Pharmacy Board
i n s p e c t o r s f u l f i l l n e i t h e r requirement.
The Board should reevaluate i t s policy of assigning vehicles t o inspectors
on a 24- hour b a s i s . There a r e two options open t o the Board. F i r s t the
Board could eliminate 24- hour vehicle assignments and require inspectors
t o commute t o the o f f i c e i n t h e i r own vehicles t o pick up t h e i r S t a t e
v e h i c l e s . Second, the Board could determine a reasonable commuting
distance f o r each inspector using a S t a t e vehicle and charge them f o r
t h i s . The DOA motor pool h a s i n d i c a t e d t h a t such " charge backs" a r e
f e a s i b l e and t h e s p e c i f i c s can be worked out by the Board. The r e s u l t i n g
charge backs a r e paid t o the DOA motor pool t o defray i t s operating c o s t s .
Travel Claims
Travel claims do not f u l l y comply with Department of Administration ( DOA)
t r a v e l p o l i c i e s . Travel claims should be more c l o s e l y reviewed f o r
compliance with DOA p o l i c i e s .
We noted thkee types of problems i n a limited review of i n s p e c t o r s ' t r a v e l
claims:
Many instances were noted where a $ 10 o r $ 20 per diem was improperly
claimed. I n 1 5 out of 32 instances noted where a $ 10 per diem was
claimed, the i n d i v i d u a l was not on t r a v e l s t a t u s according t o t h e DOA
d e f i n i t i o n . In a d d i t i o n , i n three out of f i v e instances noted where
$ 20 was claimed, the claimant was e n t i t l e d t o only $ 10. Travel s t a t u s
is defined a s being away from o n e ' s designated post of duty f o r 10 or
more hours or 6 or more hours i f t r a v e l begins at l e a s t 2 hours before
the normal s t a r t of duty or terminates a t l e a s t 3 hours a f t e r the end
of normal duty. A $ 10 per diem is paid t o those on t r a v e l s t a t u s up
t o 12 hours and a $ 20 per diem is paid f o r 12 t o 18 hours.
Personal vehicle mileage recorded on t r a v e l claims always appears t o
be the a c t u a l d i s t a n c e traveled when the claimant leaves from h i s
home. When a personal vehicle is used and a t r i p is commenced a t t h e
claimant's home, the distance traveled should be computed from e i t h e r
h i s designated post of duty or h i s home, whichever is l e s s e r .
e Travel claims examined i d e n t i f i e d only the claimants f i r s t and last
stops and i n d i c a t e a l l o t h e r s t o p s only by the notation " and p o i n t s
between." I f a n employee is required t o make s e v e r a l s t o p s during a
day while on t r a v e l s t a t u s , he does not have t o list the odometer
readings a t each stop but should show the day's beginning and ending
mileage and c l e a r l y i d e n t i f y a l l i n t e r m e d i a t e s t o p s .
Travel claims need t o be more c l o s e l y reviewed f o r compliance with DOA
t r a v e l p o l i c i e s . Board personnel should be familar with t h e s e p o l i c i e s .
The o f f i c e manager and/ or the executive s e c r e t a r y should undertake
reviewing a l l t r a v e l claims f o r the purpose of making c e r t a i n t h a t DOA
t r a v e l p o l i c i e s a r e being c o n s i s t e n t l y followed. Noncompliance with DOA
p o l i c i e s can r e s u l t i n the Board paying excessive t r a v e l c o s t s .
CONCLUSION
The Board of Pharmacy can reduce its inspection c o s t s and improve the
e f f i c i e n c y of its enforcement a c t i v i t i e s . The chief i n s p e c t o r c u r r e n t l y
wastes too much time attempting t o cover a l a r g e , dispersed inspection
t e r r i t o r y using one- day t r i p s . In a d d i t i o n , the assignment of S t a t e
vehicles t o i n s p e c t o r s on a 24- hour b a s i s r e s u l t s i n excessive c o s t s .
F i n a l l y , i n s p e c t o r s have not always complied with DOA t r a v e l p o l i c i e s .
T h i s h a s sometimes r e s u l t e d i n overstated or improperly documented t r a v e l
claims.
RECOPIMENDATIONS
1. The chief i n s p e c t o r ' s inspection t e r r i t o r y should be reassigned t o the
other i n s p e c t o r s . The chief i n s p e c t o r ' s new t e r r i t o r y should be the
area c l o s e s t t o the Board o f f i c e .
2. Board p o l i c i e s r e l a t i n g t o 24- hour vehicle assignments should be
reevaluated. E i t h e r i n s p e c t o r s ' domicile- to- duty t r a v e l s should be
eliminated, or i n s p e c t o r s should reimburse the S t a t e f o r commuting
c o s t s .
3. Travel claims should be reviewed more c l o s e l y by the o f f i c e manager
and/ or the executive secretary to ensure compliance with DOA t r a v e l
p o l i c i e s .
FINDING I11
THE BOARD'S FEE STRUCTURE CAN BE IMPROVED.
Portions of the Board of Pharmacy's f e e s t r u c t u r e and r e l a t e d procedures
should be changed. The Board's exam f e e s t r u c t u r e , a s e s t a b l i s h e d by
s t a t u t e s , is not based on c o s t s ; and it r e s u l t s i n some a p p l i c a n t s ' exam
fees being subsidized by o t h e r a p p l i c a n t s . In a d d i t i o n , a l l f e e s
c u r r e n t l y charged by the Board a r e not c l e a r l y s p e c i f i e d i n the pharmacy
s t a t u t e s .
Current Fee Structure
The Board's s t a t u t o r y maximums f o r f e e s r e l a t i n g t o pharmicists and
i n t e r n s are shown i n Table 4. Currently a l l f e e s charged by the Board a r e
s e t a t t h e i r s t a t u t o r y maximums. The Board is planning t o propose higher
maximums i n the near f u t u r e t o cover cost increases.
TABLE 4
CURRENT FEES
Fee Type
Application f o r examination
C e r t i f i c a t e of r e g i s t r a t i o n
f o r successful pharmacist
applicant
R e g i s t r a t i o n f o r pharmacy
i n t e r n
Biennial renewal f e e -
pharmicis t
Bienniel renewal f e e -
i n t e r n
S t a t u t o r v Reference
32- 1924 . A. and
32- 1924. C.
An a n a l y s i s of fees charged by t h e other 49 s t a t e s shows t h a t t h e r e is a
high degree of v a r i a t i o n , making i n d i v i d u a l comparisons very d i f f i c u l t .
However, Arizona's l i c e n s e , permit and renewal f e e s appear t o be
reasonable and not out of l i n e with the other s t a t e s .
Exam Fees Are I n e q u i t a b l e
S t a t u t e s require the Board t o charge exam f e e s which a r e i n e q u i t a b l e i n
t h a t many a p p l i c a n t s are forced t o subsidize the exam c o s t s of other
a p p l i c a n t s . Other s t a t e s have more equitable f e e s t r u c t u r e s . A more
f l e x i b l e f e e s t r u c t u r e could be designed with c o s t s taken i n t o
consideration.
The Board charges $ 100 t o a l l a p p l i c a n t s taking the n a t i o n a l exam
( NABPLEX) f o r the f i r s t time. The Board pays $ 50 t o the National
Association of Boards of Pharmacy ( NABP) f o r each five- part s e t of
n a t i o n a l exams.* This cost includes exam grading. New a p p l i c a n t s a r e
a l s o required t o take the Arizona jurisprudence exam which is prepared and
graded by Board personnel.
Some Applicants Subsidize the Exam Costs of Others - Many a p p l i c a n t s a r e
forced t o subsidize the exam c o s t s of other a p p l i c a n t s . The i n i t i a l $ 100
f e e more than covers a l l c o s t s ( approximately $ 82 per Table 5 on page 36)
d i r e c t l y a s s o c i a t e d w i t h f i r s t - t i m e a p p l i c a n t s , including a p p l i c a t i o n
processing c o s t s . A. R. S. $ 32- 1924. A., however, s t a t e s t h a t " payment of
t h e f e e s h a l l e n t i t l e t h e a p p l i c a n t t o take a second examination i f he
f a i l s i n h i s f i r s t examination, but the second examination s h a l l be within
one year of the f i r s t examination."** This r e s u l t s i n the Board sometimes
incurring a s much a s $ 70 i n a d d i t i o n a l c o s t s ($ 59 and $ 11 according t o
Table 5 on page 36) when there i s no corresponding revenue. This c o s t is
subsidized by the $ 100 f e e charged t o paying a p p l i c a n t s .
* The c o s t t o the Board f o r each s e t of n a t i o n a l exams w i l l go up t o $ 75
i n 1985. ** According to the Board's i n t e r p r e t a t i o n of t h i s s t a t u t e , a p p l i c a n t s
taking the exam f o r the f i r s t time or retaking the exam an odd number
of times must pay $ 100. Applicants retaking the exam an even number
of times pay nothing. An a n a l y s i s of the exams given i n June 1982 and
January 1983 shows 10 of the 95 a p p l i c a n t s taking the exam paid
no thing.
Other S t a t e s - Other s t a t e s 1 pharmacy boards have more equitable exam f e e
s t r u c t u r e s . An a n a l y s i s was done on the exam f e e s of 11 western s t a t e
pharmacy boards t h a t use the national exam ( NABPLEX)." No s t a t e surveyed
has an u n q u a l i f i e d p o l i c y of allowing a second examination to be taken a t
no charge a s Arizona has. Only three s t a t e s have provisions f o r f r e e or
reduced- fee retakes; however, the degree t o which some applicants1 exam
c o s t s a r e subsidized by o t h e r s i s minimal i n a l l of t h e s e t h r e e instances.
6 Kansas allows its state- administered l a b or jurisprudence exams t o be
retaken f o r only $ 25. I f the NABPLEX is f a i l e d , however, t h e r e t a k e
f e e is a f u l l $ 125.
Montana, which purchases the NABPLEX by p a r t s , allows a f r e e retake
only i f one p a r t is f a i l e d , otherwise the f e e is a f u l l $ 75.
Washington allows its state- administered law exam t o be retaken f o r
f r e e i f NABPLEX i s e n t i r e l y passed, otherwise the f u l l $ 85 f e e must be
paid.
An Equitable Exam Fee S t r u c t u r e Is Possible - S t a t u t e s could be amended t o
allow a more equitable exam f e e s t r u c t u r e based on c o s t s . The r e s u l t s of
a u d i t s t a f f a n a l y s i s of c u r r e n t c o s t s connected with exams and a p p l i c a t i o n
processing a r e shown i n Table 5. As shown i n t h i s t a b l e , a f e e of
approximately $ 82 f o r i n i t i a l a p p l i c a n t s may be reasonable. Separate f e e s
of approximately $ 12 f o r jurisprudence retakes and $ 65 f o r national exam
retakes would give the f e e s t r u c t u r e added f l e x i b i l i t y . A f l e x i b l e f e e
schedule based on Board c o s t s , such a s t h a t shown i n Table 5, would be
f a i r t o a l l a p p l i c a n t s .
* The 11 s t a t e s surveyed a r e Colorado, Idaho, Kansas, Montana, Nevada,
New Mexico, Oregon, Texas, Utah, Washington and Wyoming.
National exam
Jurisprudence
exam
Application
processing
TABLE 5
CURRENT EXAM AKD APPLICATION COSTS
Appropriate Fee
Grading ( Includes 10 Percent
Exam and Administration Total Contribution t o
Cost Preparation Costs Cost S t a t e General Fund) a
* This does not include p o s s i b l e i n c r e a s e s i n NABPLEX f e e s ( going t o $ 75 i n 1985)
and o t h e r i n c r e a s e s due t o i n f l a t i o n o r other unforeseen f a c t o r s .
Grade C e r t i f i c a t i o n Fee Not
C l e a r l y S p e c i f i e d i n S t a t u t e s
The Board i s charging a f e e not c l e a r l y s p e c i f i e d i n the s t a t u t e s . The Board's
r u l e s and r e g u l a t i o n s r e q u i r e payment of an examination grade c e r t i f i c a t i o n f e e
of $ 10 which is n o t a u t h o r i z e d i n t h e s t a t u t e s . Although the s t a t u t e s give the
Board the a u t h o r i t y t o e s t a b l i s h r u l e s and r e g u l a t i o n s necessary f o r the
p r o t e c t i o n of t h e p u b l i c , the s t a t u t o r y a u t h o r i t y f o r the above- mentioned f e e
should be made more c l e a r .
A f e e of $ 10 i s required by the Board's r u l e s and r e g u l a t i o n s ( R4- 23- 202L) f o r
" c e r t i f i c a t i o n of grades made on examinations." The r u l e s and r e g u l a t i o n s a r e
not c l e a r on when t h i s f e e i s t o be c o l l e c t e d . According t o Board personnel,
however, i t is c o l l e c t e d from a pharmacist who requests h i s grades be s e n t t o
another s t a t e where he o r she is seeking r e c i p r o c i t y .
a
Although the Board has a u t h o r i t y t o promulgate r e g u l a t i o n s f o r the
p r o t e c t i o n of t h e p u b l i c and f o r the lawful performance of its d u t i e s , the
r e g u l a t i o n requiring the $ 10 grade c e r t i f i c a t i o n f e e should be more
s p e c i f i c a l l y covered i n the s t a t u t e s . The L e g i s l a t i v e Council, i n a
s t a t u t o r y i n t e r p r e t a t i o n , pointed out t h a t
" There is no s t a t u t o r y provision which even mentions
such a f e e o r c e r t i f i c a t i o n of exam grades."
Although the $ 10 grade c e r t i f i c a t i o n f e e may be authorized under the
Board's general rule- making a u t h o r i t i e s , the L e g i s l a t i v e Council
recommends t h a t
" The pharmacy s t a t u t e s should be amended so t h a t each
of the f e e s t o be charged by the Board is c l e a r l y
s p e c i f i e d . "
This would avoid any p o s s i b i l i t y f o r confusion i n the f u t u r e .
CONCLUSION
The pharmacy s t a t u t e s specify an exam f e e s t r u c t u r e which is i n f l e x i b l e
and u n f a i r t o some a p p l i c a n t s . I n a d d i t i o n , the $ 10 grade c e r t i f i c a t i o n
f e e required by the Board's r u l e s and r e g u l a t i o n s i s not c l e a r l y
authorized by the s t a t u t e s .
RECOPPIENDATIONS
The L e g i s l a t u r e should consider amending the pharmacy s t a t u t e s a s follows:
1. Eliminate the provision f o r a f r e e second examination.
2. Add more f l e x i b i l i t y t o the exam f e e s t r u c t u r e t o allow separate f e e s ,
m based on Board c o s t s , f o r the jurisprudence and n a t i o n a l exams.
3. S t a t u t o r i l y authorize the $ 10 grade c e r t i f i c a t i o n f e e c u r r e n t l y
required by the Board's r u l e s and regulations.
OTHER PEF. T INENT INFORMATION
During the a u d i t , o t h e r p e r t i n e n t information was developed regarding
1) Board i n s p e c t o r s ' r e l a t i o n s h i p s with the S t a t e a s s o c i a t i o n , 2) the
consistency of s t a t u t e s r e l a t e d t o c i v i l p e n a l t i e s , 3) t h e s t a t u t o r y
a u t h o r i t y s f the Board t o r e g u l a t e patent and p r o p r i e t a r y o u t l e t s , and
4) the use of the t i t l e of doctor.
Board I n s p e c t o r s ' Relationships
with Association
A Board inspector is c u r r e n t l y the chairman of the Arizona Pharmacy
Association's P o l i t i c a l Action Committee ( PAC). This is a nonpartisan
fund r a i s i n g committee t h a t lobbies f o r pharmacy- related l e g i s l a t i o n and
c o n t r i b u t e s t o the campaigns of l e g i s l a t i v e candidates. Contributions
primarily come from pharmacists. S t a t e law provides t h a t
" No employee . . . may be a member of any n a t i o n a l ,
s t a t e o r l o c a l committee of a p o l i t i c a l party, or an
o f f i c e r or chairman of a committee of a p a r t i s a n
p o l i t i c a l club. . . ." ( A. R. S. $ 41- 772.~.)
Attorney General Opinion number 71- 1 s t a t e s t h a t
" The apparent l e g i s l a t i v e i n t e n t i n providing these
s t a t u t o r y r e s t r i c t i o n s a g a i n s t employees engaging i n
p o l i t i c a l a c t i v i t y was t o i n s u r e t h a t employees can
f u l l y and properly discharge t h e i r d u t i e s and
r e s p o n s i b i l i t i e s of S t a t e service employment with
i m p a r t i a l i t y , f r e e from any t a i n t of f a v o r i t i s m ,
prejudice, personal ambition, or p a r t i s a n demands."
Moreover, S t a t e Personnel Board r u l e s and r e g u l a t i o n s s t a t e t h a t
" The employee s h a l l not engage i n . . . other a c t i v i t y
which is not compatible with the f u l l and proper
discharge of the d u t i e s and r e s p o n s i b i l i t i e s of h i s
S t a t e Service employment, o r which tends t o impair h i s
capacity t o perform h i s S t a t e Service d u t i e s and
r e s p o n s i b i l i t i e s i n an acceptable manner."
[ R2- 5- 401 B ( 8 ) ]
Although t h e Pharmacy Associations's P o l i t i c a l Action Committee ( PAC) is
nonpartisan, holding the p o s i t i o n of chairman might impair a Board
i n s p e c t o r ' s capacity t o perform h i s Board d u t i e s and r e s p o n s i b i l i t i e s . An
inspector who is the PAC chairman may be required t o s o l i c i t funds from
pharmacists he i n s p e c t s . T h i s could r a i s e a question a s t o whether
i n s p e c t i o n s a r e handled i m p a r t i a l l y and f r e e from prejudice.
Additionally, the Association could take a p o s i t i o n on a n i s s u e t h a t the
Board does not agree with, c r e a t i n g a p o t e n t i a l c o n f l i c t of i n t e r e s t f o r
the inspector. We found, however, no evidence t o i n d i c a t e t h e inspector
has ever f a i l e d t o acceptably perform h i s d u t i e s as a Board employee.
When a u d i t s t a f f pointed o u t t h e s e possible c o n f l i c t s t o t h i s inspector,
he resigned h i s p o s i t i o n with the PAC. This inspector a l s o previously
served a s the a s s o c i a t i o n ' s president while employed by the Board.
In a d d i t i o n t o the inspector discussed above, another past pharmacy
a s s o c i a t i o n president was a l s o a Board inspector. Furthermore, one Board
member is c u r r e n t l y on the a s s o c i a t i o n ' s board of d i r e c t o r s , and t h i s
p o s i t i o n has been held by another Board member i n the past.
S t a t u t e s Related t o C i v i l P e n a l t i e s or Censure
A 1982 s t a t u t o r y amendment, which authorizes the Board t o impose c i v i l
p e n a l t i e s or t o censure a l i c e n s e e , is unclear a s t o a pharmacist's r i g h t s
t o a hearing. In an opinion dated May 27, 1983, the L e g i s l a t i v e Council
suggested t h a t a c l a r i f i c a t i o n of s t a t u t e s may be d e s i r a b l e :
" A. R. S. Section 32- 1927 was amended i n 1982 t o allow
the board t o impose c i v i l p e n a l t i e s on or censure
pharmacists or pharmacy i n t e r n s f o r c e r t a i n
v i o l a t i o n s . These two new d i s c i p l i n a r y sanctions were
not added t o A. R. S. Section 32- 1928, subsection A a t
t h a t t i n e . After reviewing when and where t h i s
amendment was adopted t h i s o f f i c e believes it is
unlikely t h a t the l e g i s l a t u r e intended the board could
impose a c i v i l penalty on or censure a pharmacist or
pharmacy i n t e r n without n o t i c e and an opportunity f o r
a hearing. A. R. S. Section 32- 1928, subsection A
probably should be conformed t o A. R. S. Section
32- 1927, subsection B by adding imposition of a c i v i l
penalty and censure i n order t o avoid f u t u r e
confusion. "
Regulation'of Patent and
P r o ~ r i e t a r vO utlets
A. R. S. s1904. C. may c r e a t e confusion regarding the Board's a u t h o r i t y t o
r e g u l a t e patent and p r o p r i e t a r y o u t l e t s . T h i s s u b s e c t i o n s t a t e s :
" Nothing i n t h i s s e c t i o n s h a l l be construed a s granting
the board the a u t h o r i t y t o deny o r r e s t r i c t t h e r i g h t
of any permittee t o s e l l patent and p r o p r i e t a r y
medicines."
The Board's attorney general r e p r e s e n t a t i v e s t a t e d t h a t t h e o r i g i n a l
i n t e n t of t h i s subsection was probably t o prevent the Board from
r e s t r i c t i n g the drugs sold by patent and p r o p r i e t a r y o u t l e t s ( i . e . ,
over- the- counter drugs). Over- the- counter drugs a r e designated by the
Food and Drug Administration. This subsection, however, has been c i t e d i n
a t l e a s t one l e g a l a c t i o n taken against the Board. I n t h a t case, the
p l a i n t i f f was attempting t o show t h a t t h e Board did not have any a u t h o r i t y
t o regulate the name used by a patent and p r o p r i e t a r y o u t l e t under A. R. S.
$ 32- 1961.~.( 3) .* Because the general language of s1904. C. is open t o
broad i n t e r p r e t a t i o n , t h e Board's executive s e c r e t a r y would l i k e t o have
r e s t r i c t i o n s on the Board's a u t h o r i t y c l a r i f i e d .
* A. R. S. $ 32- 1961.~.( 3) makes it unlawful t o use c e r t a i n words, such a s
" drugs," i n the t i t l e of a s t o r e t h a t does not have a licensed
pharmacist i n a c t i v e personal charge.
T i t l e of Doctor
A nationwide controversy c u r r e n t l y e x i s t s concerning the t i t l e pharmacists
should use. Professional a s s o c i a t i o n s i n a s many as 28 s t a t e s a c r o s s t h e
country a r e supporting the " Doctor of Pharmacy" or " PD" t i t l e . They argue
t h a t pharmacists should have a t i t l e s i m i l a r t o t h a t of other h e a l t h care
p r o f e s s i o n a l s e . , medical doctors). Opponents argue t h a t the PD
designation is misleading and conveys a t i t l e not earned, since most
pharmacists have only a bachelors degree.* S t a t e boards of pharmacy
appear t o be divided on how they a r e responding t o t h i s s i t u a t i o n . Many
a r e remaining n e u t r a l , apparently because the matter of t i t l e does not
d i r e c t l y a f f e c t t h e p r a c t i c e of pharmacy. Other s t a t e boards have opposed
the t i t l e change. To date only one s t a t e , Tennessee, has a c t u a l l y
l e g i s l a t e d the t i t l e of doctor f o r pharmacists. The Arizona Board of
Pharmacy has no o f f i c i a l p o s i t i o n and no j u r i s d i c t i o n i n t h i s area.
The Arizona Pharmacy Association, the S t a t e ' s p r o f e s s i o n a l a s s o c i a t i o n of
pharmacists, is s e l l i n g " Doctor of Pharmacy" c e r t i f i c a t e s t o Pharmacists
licensed i n Arizona without the approval of the Board of Pharmacy. The
Association has been s e l l i n g " Doctor of Pharmacy" c e r t i f i c a t e s since June
1982 t o any pharmacist r e g i s t e r e d i n the S t a t e . Approximately 500 have
been sold. There is c u r r e n t l y no S t a t e law or r u l e t o prevent or regulate
the s a l e of such c e r t i f i c a t e s , and the Board of Pharmacy has no a u t h o r i t y
t o a c t .
* Currently a doctorate degree i n pharmacy can be earned, but i t takes
approximately four years of post graduate education. Proponents of the
" PD" designation, however, a r e arguing f o r a p r o f e s s i o n a l t i t l e f o r a l l
pharmacists not t i e d t o post graduate education.
AREAS FOR FURTHER AUDIT WORK
During the course of our review of the Board of Pharmacy, we i d e n t i f i e d
s e v e r a l a r e a s f o r f u r t h e r a u d i t work. These i s s u e s , which were beyond the
scope of our review due t o time c o n s t r a i n t s , include:
Whether the Board's r e c i p r o c i t y policy is too r e s t r i c t i v e ,
Whether the national exam should be administered i n Phoenix r a t h e r
than i n Tucson,
The adequacy and e f f i c i e n c y of the Board's renewal schedules, and
The need f o r the Board t o develop uniform d i s c i p l i n a r y a c t i o n
guidelines.
1645 WEST JEFFERSON, ROOM 127
PHOENIX. ARIZONA 85007
PHONE: 6 0 2 - 2 5 5 - 5 1 2 5
JOHN P. STREET, R. PH.
EXECUTIVE SECRETARY 3
August 18, 1983
Mr. Douglas R. Norton
Auditor General
111 West Monroe. Suite 600
JOSEPH J. ROWAN, R. PH.. SEDONA
PRESIDENT
BETTINA D. LOPEZ. R. PH.. TUCSON
VlCE. PRESIDENT
JOHN BURNHAM. TUCSON
MEMBER
GLEN E. CRANDALL, R. PH., PARADlsE VALLEY
MEMBER
SIMON J. EISENBERG. R. PH., SCOTTSDALE
MEMBER
ADALINE PANGRAZI. GLENDALE
MEMBER
THOMAS M .
MEMBER
SAMUELS, R. PH., TUCSON
Phoenix, ~ r i z o n a 85003
Re: Comments on the Performance Audit of the Arizona State Board
of Pharmacy
Dear Mr. Norton:
Thank you for your l e t t e r of August 16, enclosing your revised prelimi-nary
report draft of the performance audit of the Board of Pharmacy.
The Arizona State Board of Pharmacy i s pleased to express i t s apprecia-tion
t o the Auditor General's Sunset Review Team for their handling of the
review of the Board's a c t i v i t i e s . Board members have worked diligently to
administer their legislative charge to protect the public in relation to the
practice of pharmacy and the manufacturing, wholesaling or supplying of drugs,
devices, poisons or hazardous substances. I t is therefore gratifying to read
in the report that " the Board has significantly improved i t s enforcement
program", and " has increased the number of disciplinary actions taken and has
improved complaint investigation procedures".
In addition, the Auditor General's Review Team determined for the " Sunset
Factors" that the Board has generally met i t s objective and purpose effectively
and efficiently. The Board wholeheartedly endorses the conclusions in the
Sunset Factors:
1. The Board has generally met i t s objective and purpose through
licensing, inspection, and investigations of those persons and
f a c i l i t i e s related to the practice of pharmacy. These have all been
improved with the introduction of new policies and procedures, and
supported by word processing and a new f i l i n g system.
2. The Board's enforcement functions serve the public i n t e r e s t , since
the Board has taken s t r i c t enforcement action on complaints and
inspection- related violations.
3. The Board has generally addressed d e f i c i e n c i e s i n i t s enabling
s t a t u t e s . Further, the board i s i n agreement w i t h the l e g i s l a t i v e
changes recommended by the Review Team.
Recommended L e g i s l a t i o n
The Penformance A u d i t r e v i e w recommends t h a t the L e g i s l a t u r e should
consider:
1. Amending the insurance code t o r e q u i r e r e p o r t i n g o f malpractice
claims and settlements t o the Board.
Commen t :
The Board agrees w i t h t h i s recommendation. At present t h i s
i n f o r m a t i o n u s u a l l y i s never provided t o the Board, and serious or
r e p e t i t i v e actions o f a licensee would go undetected.
2. Amending A. R. S. 5 32- 1924 t o make the Board's exam f e e s t r u c t u r e more
f l e x i b l e and f a i r t o a l l applicants.
Comment :
The Board agrees t h a t such an amendment would provide equitable
examination costs f o r a l l candidates. E s t a b l i s h i n g a maximum exami-n
a t i o n cost, which could be adjusted by r e g u l a t i o n , and a r e - t a k e
charge equal t o the o r i g i n a l examination cost would equalize the
costs f o r candidates and prevent s u b s i d i z a t i o n and loss of revenue by
the Board.
3. Enact s t a t u t o r y a u t h o r i z a t i o n f o r the grade c e r t i f i c a t i o n fee.
Commen t :
The Board agrees t h a t t h i s s t a t u t e i s v i t a l . As d e t a i l e d i n the
r e p o r t , the Board i s charging a f e e n o t c l e a r l y s p e c i f i e d i n the
s t a t u t e s , but which i s i n the Board's a u t h o r i t y . A s t a t u t e would
c l a r i f y t h i s p o i n t .
4. Amend A. R. S. $ 32- 1928. A t o conform w i t h A. R. S. $ 32- 1927. B w i t h
regard t o c i v i l p e n a l t i e s and censure.
Comment :
The Board agrees w i t h t h i s recommendation. This was obviously an
oversight when A. R. S. 5 32- 1927 was amended i n 1982 t o provide f o r
" censure and c i v i 1 penalty" .
F u r t h e r , the Board would l i k e t o recommend t h a t A. R. S. 5 32- 1924. A,
A. R. S. 5 32- 1924. B, A. R. S. 5 32- 1924. C, A. R. S. 5 32- 1925. F, and A. R. S. 5
32- 1931. E be amended t o e s t a b l i s h higher maximums on fees which the Board can
charge. C u r r e n t l y a l l fees charged b y t h e Board are a t t h e i r s t a t u t o r y
maximums.
Findings
Procedural recommendations were provided by the Review Team and
documented in Findings I, 11, and 111. The board concurs with their findings
and has initiated corrective action to improve its enforcement procedures to
further reduce the potential for public harm:
1. he Board's enforcement procedures could be improved to further
reduce the potential for public harm. This finding was divided into
three areas: ( a) Complaint investigation adequacy, ( b ) relay of
information to pharmacists regarding disciplined medical practitioners,
and ( c) needed information on pharmacy- related malpractice insurance
claims.
a. The board has implemented a new policy and procedure format
on complaint investigations. A review procedure for the
completed investigation now ensures that all parties involved
are informed of final dispositions. Cross- filing of these
reports provides cumulative data on licensees.
b. The statute requiring the relay of information to pharmacists
regarding disciplined medical practitioners became effective
in July, 1982. With only minimal space available in the
Board's quarterly newsletter, a new method for this reporting
was necessary. The format for publication of this data has
been established and been implemented with the first report
scheduled for September, 1983.
c. No action can be taken by the Board to obtain information on
pharmacy- related malpractice insurance claims without the
enactment of necessary statutes.
2. Pharmacy inspections can be performed in a more efficient and less
costly manner. This finding was divided into three areas: ( a)
inspection areas and travel time, ( b) state vehicle assignments, and
( c) D. O. A. travel polices.
a. Inspection areas have been reassigned with the Chief
Inspector covering a territory nearest to the Board office.
This will allow him to spend more time at office duties, and
to be available for assistance to other inspectors on special
ass i gnmen ts .
b. In accordance with D. O. T. Motor Pool recommendations a
" charge back" system is being initiated which requires the
inspectors to reimburse the State for commuting costs.
c. Travel claims are now being reviewed closely by both the
office manager and the executive secretary for compliance
with D. O. A. travel policies.
The Board of Pharmacy again thanks you and your s t a f f f o r your courtesy
and s i n c e r i t y . a
Sincerely,
, $ 2 ~ Joseph 0@- J. Rowan
president
cc: Members of the Board
Executive Secretary