CHARLOTTE, N.C. -- When you go to the drugstore, are the pharmacists so busy they're more likely to get your prescription wrong? 

An I-Team review of a decade's worth of North Carolina Pharmacy Board data and documents finds one chain of drug stores has the highest number of citations for medication mistakes in which the board found the pharmacist was so busy the chain put patients at risk.

That chain: CVS.

CVS has 285 stores in North Carolina -- about three on average for every county -- and more than any other chain in the state.

The Pharmacy Board has repeatedly cited CVS itself for creating working conditions in which the board found pharmacists are more likely to make mistakes.

CVS respects the board's authority but differs with its conclusions.

ONE PHARMACIST'S EXPERIENCE

Josh Rimany went through leukemia as a kid. The experience motivated him to want to work in health care. So he started his career at CVS as a teenager.

"I wanted to get into the health care system because I was so fortunate to have people help me," says Rimany.

He became a pharmacist at CVS. He worked there for about 15 years all told -- almost 10 of them as a pharmacist. But in July he quit CVS and started his own independent pharmacy, Dilworth Drugs in Charlotte. Rimany made the change, he says, "Because I felt year after year I was given less and less to do more and it came down to patient care for me. I couldn't care for the patient in a way I thought was appropriate."

Just what is "appropriate" patient care for a pharmacist?

The North Carolina Board of Pharmacy has a guideline for the number of prescriptions a pharmacist can safely fill in a single day -- 150.

That's 150 prescriptions filled per pharmacist per day.

But Rimany says some days at CVS he filled a lot more than that: "I think I recorded over 500 with just one pharmacist -- myself -- on duty ... It's to the point where you feel like you're numb. You're burnt out."

Asked if a pharmacist was more prone to make a mistake filling that many prescriptions, Rimany replies, "Absolutely."

CVS DISAGREES

CVS, like other chain pharmacies, disputes the premise that a busy workday makes a pharmacist more likely to make mistakes.

CVS spokesman Michael DeAngelis e-mailed a statement in response to the I-Team's questions, saying, "The health and safety of our customers is our highest priority and we never compromise safety for dispensing speed or prescription volume." ( Complete Statement and e-mail Q&A)

The statement goes on to say the NC Pharmacy Board's 150-prescription/day guideline is "subjective" and does not take into account the length of a pharmacist's shift, whether the error was made early or late in the day, or CVS's "billion" dollar investment in technology and automation to make the process more efficient.

PATIENT'S EXPERIENCE

Kay Rayfield of Boiling Springs once worked in a pharmacy in Shelby.

"I think they're in too big of a hurry now," says Rayfield.  

Last year she went to a CVS store in Gaffney, S.C., with a prescription for Requip -- a medicine for restless leg syndrome. In a bottle she says was marked "Requip" she instead got Wellbutrin -- an antidepressant. Not long after she took the drug she noticed the difference.

She told her husband, "Something ain't right. I said this medicine's not doing right cause it made me, you know, jerky -- jittery."

Rayfield apparently suffered no lasting effects from the pharmacy error.

But as someone who worked in a pharmacy, she knows the potential danger: "They could kill somebody."

REPEATED DISCIPLINARY ACTIONS

Last year a pregnant Salisbury elementary school teacher went to the CVS store on E. Innes Street in Salisbury for an anti-nausea medicine. The CVS pharmacist instead gave her a drug meant for patients with multiple sclerosis or spinal injuries. The teacher filed a complaint and the board sent CVS a letter of warning.

The NC Pharmacy Board does not audit pharmacies to determine how many prescriptions each fills. But after an error, board investigators look back to see how many prescriptions were filled on the day of the mistake.

In the case of the E. Innes Street CVS, the answer was 515 -- more than triple the state guideline.

The I-Team found the NC Pharmacy Board cited CVS at least a dozen times in the last 10 years for making mistakes while filling what the board concluded were too many prescriptions to be safe. ( List of cited CVS stores and dates)

Three times this year alone, at CVS stores in Glen Raven, on Main Street in Davidson and on Gilead Road in Huntersville, the board cautioned or warned CVS about what it called "dispensing prescriptions at a dangerously high rate."

The way pharmacist Josh Rimany sees it, "Every chain pharmacy is always volume driven. There's always a stat on how many prescriptions per day, prescriptions per month that you're doing."

INCENTIVE PAYOUTS

In fact CVS pays its pharmacists and "team leaders" cash bonuses based on volume -- how many "scripts" the pharmacists fill.

The I-team obtained a 2008 "Pharmacist Incentive Update" for one CVS store. ( Read the update) It shows the company assigns each store a specific number of "budgeted scripts."

One portion of the pharmacists' incentive payout at the end of the year is based on the actual number of scripts, which exceed the "budgeted" number.

CVS pharmacists get periodic updates so they can gauge how many thousands of dollars they'll make if they keep putting pills in bottles at the current rate.

Pharmacist Josh Rimany says over the course of his tenure at CVS, "The volumes have increased and the pharmacist hours decreased ... so the numbers are going up but the hours are going down."

The CVS spokesman, Michael DeAngelis, wrote that "CVS pharmacists are not incented based on how quickly they fill prescriptions."

But he acknowledges computers time CVS pharmacists. In-store customers get priority. And when pharmacists take longer than promised to fill a prescription for a waiting customer, a red line appears on the pharmacists computer screen in the "cue." Enough red lines dock a pharmacist's performance evaluation, which in turn effects incentive pay.

The CVS spokesman wrote, "While we never compromise safety for speed, quality healthcare requires a level of urgency in specific defined circumstances."

Josh Rimany says, "It's alarming because their priority -- they're telling you -- their priority is volume -- to make more money and to do more prescriptions."

CVS offers two other categories of incentive pay for pharmacists -- one for the number of generic drugs substituted for name-brand medicines and one for customer service.

But at the store for which the I-Team obtained records, more than 80 percent of the pharmacists' incentive pay came from the number of scripts filled.