|Author: Bettijane Eisenpreis|
|Independent Pharmacist Continues Tradition|
|Truman, Minnesota (population 1,300) boasts "an independent school district, exceptional quality of life and a safe atmosphere to raise a family." The town's healthcare system includes a family practice doctor, a dentist, a 113-bed state-of-the-art nursing home ˘ and one pharmacy, Truman Drug, Richard Lauring, Proprietor.
Richard Lauring, RPh, represents the third generation of his family to become a pharmacist. There is now a fourth generation: Richard's daughter. However, while Lauring owns and operates his own drugstore, his daughter works for an HMO in the Twin Cities.
"My grandfather and uncle were pharmacists," he continues. "I liked the independence a pharmacist could have by owning a business. But I doubt that my daughter will ever own a drugstore because she has no desire to. I'm the only pharmacy in town, and when I quit here, it will be the end."
For a self-professed member of an endangered species, Lauring sounds amazingly robust. Asked where he sees himself in ten years, he replies, "I will probably be doing what I am doing now." He employs a number of strategies to keep his business viable and himself active. "We put in watch batteries and fix cameras and offer a wide variety of merchandise," he says. "That is normal for a small-town drugstore to offer other services to the community."
Lauring hails from Coleraine, a town of 1,000 in the Iron Range area of Northeastern Minnesota. "My dad was a mining engineer," he says. "My father's side of the family was Swedish, and they were all into education. We all graduated from the University of Minnesota."
Growing up in Coleraine in the 1940s and 50s was "the American dream," Lauring reports. "Because of the wealth of the mines, the school system was excellent.Ê The unions came in the thirties and gave the men a fair shake. It was easy to get along because everybody lived well. You had a boat and a car and there were 1,000 lakes in the county. We would all go fishing and hunting together."
Many of the mines that existed in Lauring's boyhood have closed. "Today there are about five mines. They are all on a big scale and employ very few people." Unlike many of his childhood friends, Lauring continues to like small-town living. So when he had an opportunity to buy a pharmacy in Truman, a farming community near the Iowa border, he jumped at the chance.
"I was looking for a pharmacy to buy from the day I got out of college," he says. "I would say two-thirds of my class owned a drug store at one time or another. I made about $10,000 working for Walgreen's, which was a lot of money in 1965. But if you bought a drugstore and took a risk, you could make about $25,000. I put out the word that I wanted to buy a retail pharmacy and in July 1968, I purchased this store. In 1976, I built a new and larger building and moved across the street."
"In the 30 years that I've been here," Lauring explains, "small pharmacies are gradually going out of business. A man in a town 15 miles away, who is about ten years older than I am, just closed out his store, after trying for a long time to sell it. I told him, 'Harold if you ever sell, I will too, but I don't think you'll ever sell it.' Within a 100-mile radius around here, about one drugstore a year closes out. I don't see that stopping because the economic numbers don't work."
Nevertheless, he perseveres. "If you can find ways to cut your costs you can do quite well in your own store," he adds."I own my own building. A contractor came in 25 years ago and gave me a good deal, so we were able to build a nice 5,000-square-foot building. I picked up my fixtures basically free from stores that went out of business. Some are probably 40 years old, but you wouldn't know it." He keeps up with the times. "I found a good computer vendor, so for $500 a year I have an excellent computer program that would probably cost $5,000 a year to rent, which submits all my claims and prints my labels."
Since 1988, Lauring has been on staff at a hospital in the neighboring community of Madelia. He serves as sole dispensing pharmacist for the Lutheran Retirement Home and Manor apartments, Truman's senior citizen facility.
Lauring enjoys his work at the 17-bed Madelia hospital. "The hospital is run by a small board of directors. It's very efficient. I'm very happy with what they pay me, because they make it easy to get the work done. I oversee all their dispensing, onsite when necessary but often from here. I get a lot of help from the nurses and the people who work there. The cooperative attitude is probably why that little hospital is one of the few that is financially strong. The three doctors do all the emergency room work. They don't have doctors who just come in to cover the emergency room."
As for the nursing home in Truman, Lauring says, "There would be no economic sense to staying here if it wasn't here. It was built a couple of years after I came here and bought the little store. Again, it's convenience. That is a two-way street. I have to offer them something in order to get something."
While Lauring has a good relationship with the nursing home, there is one problem that, he says, "has hurt small drugstores in rural areas. Years ago, the state pharmacy board classified pharmacists as either vendors or consultants. Because of a potential conflict of interest, they suggested strongly that no pharmacist should fill both roles. So I am the vendor but I do not consult. I can see in the cities, after the Enron mess, the consultant should not also be the accountant. But in rural communities, we need every revenue stream we can get. It is taking money out of these towns to bring in somebody who drives around in a car to do something I believe I could do just as well."
While this is a minor annoyance, the automobile and the HMO pose far more serious threats to pharmacies like Laurin's. "Although I'm the only pharmacy in town, there are chain stores around me and the roads are good. People think nothing of driving 20 or 30 miles to go shopping. Then, too, there's mail order. A lot of folks buy all their pharmaceuticals without walking out of their front doors."
One of Lauring's biggest headaches is negotiating a maze of government and health insurance regulations. "This is a farming area where there are no large employers, so most people are on their own in buying health insurance. I don't accept reimbursement from any but the welfare-related plans, because it just isn't cost-effective."
"Medicare is another interesting issue," he continues. "While the cost of prescription drugs is not covered, a loophole in the Medicare law states that if one buys a machine of any kind, the supplies for it are covered. On the television ads, Wilfred Brimley tells his audience that one can get diabetes supplies free by mail, which is true. Diabetes test strips must be read by a machine, so if one get the machine through Medicare, one can get the strips free for the rest of his life."
"Another example is an asthma inhaler. Handheld Albuterol inhalers are not covered by Medicare, but if I buy an expensive machine called an IPPV or Medi Machine, Medicare pays for it and Albuterol is free."
In order to make these services available to his customers, Lauring finds himself mired in red tape. "I had to write congressmen and all kinds of people because I was submitting as an independent," he says. "They make you fill out a form that a doctor uses to do surgery and it has to have all fields filled in exactly right. It took me about six months to a year and I had to have the Attorney General's office contact the supplier. There is a manual to refer to, and it is about 1,000 pages long and includes information about hip replacement and everything else, just to sell diabetes test strips. I finally have been able to do that but it's nasty stuff."
Lauring believes that allowing pharmacists to prescribe certain drugs would benefit consumers and pharmacists. "In Florida there is a list of drugs that pharmacists can prescribe. It's a very limited list, but it's a start. I would like to see a similar list in Minnesota, including medications like Zantac and Pepcid. We sell 75-milligram Zantac tablets over the counter, but we can buy 150 milligrams in bulk for less than five cents a tablet. Of course a doctor must prescribe the higher dosage. They tell us we can't prescribe because are no instructions on the bottle. However, we are required by law to give customers a preprinted Med Guide with each prescription drug, spelling out detailed instructions. If rural pharmacists could act independently in areas like this, we might be able to survive."
Giving pharmacists more control could also aid law-enforcement, Lauring says. "In this little county of 24,000 people, every year the police arrest five or six people running so-called meth labs in their houses. The government could close those labs down by expanding the list of Class 5 drugs, which can only be sold by pharmacists, to include ephedrine and pseudoephedrine, the key ingredients for making methamphetamine." Pressure from firms who promote the use of the drugs for weight loss has, he believes, helped to prevent expansion of the list.
Lauring belongs to the Minnesota Pharmacists Association and the National Community Pharmacists Association (NCPA). Although he does not attend meetings, he uses the organizations "as a sounding board" to speak out on issues that concern him. One such issue is health care coverage. "What we call health insurance in the U.S. is really prepaid coverage. If you buy a $10,000 life insurance policy, your children - whether you have one or ten -- will get $10,000 when you die. But when people need high-tech procedures not covered by their insurance, they feel entitled. Often they sue and win. That's why premiums keep going up. Something will have to be done, but I don't think it will be soon."
Richard Lauring, RPh, received his associate degree from Itasca Junior College and his BS, Rho Chi, in 1963 from the University of Minnesota. He served three terms on the Truman school board, resigning in 1991 when his youngest child graduated from high school. He belongs to several community organizations such as the Lions Club and the Development Club for Truman.
Bettijane Eisenpreis is a freelance writer from New York City, and is on the Editorial Staff of NEWS-Line for Pharmacists.