Aug 27, 2001, 04:33 PM
One more posting for those that are interested in following this story:
Diluted-Drug Case Hinged on Luck
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Story Filed: Friday, August 24, 2001 2:52 PM EDT
KANSAS CITY, Mo. (AP) -- Robert R. Courtney, the pharmacist accused of diluting chemotherapy drugs, was caught not by a government inspector, but by a drug salesman who noticed Courtney was billing doctors for more medication than he was buying, investigators say.
Industry experts say regulatory agencies are so understaffed that catching crooked pharmacists can be a matter of luck.
And drug companies cannot be expected to watch every druggist, said Jeffrey Newton, a spokesman for Eli Lilly, maker of the chemotherapy medicine Gemzar.
Prosecutors say Courtney, 48, made thousands of dollars by diluting Gemzar and Taxol with saline, denying potentially lifesaving medicine to perhaps hundreds of cancer patients. Unlike most other pharmacists, Courtney mixed the intravenous bags of medicine that he sold to doctors.
So far, Courtney is charged with 20 counts of altering medication. Investigators are still looking into whether the scheme contributed to the deaths of any patients. Courney has been hit with at least one lawsuit so far over a woman's death from ovarian cancer.
His lawyer said he will plead innocent.
``If you don't have people occasionally looking over your shoulder, you don't have the incentive to do what you should do,'' said Dr. Michael R. Cohen, a pharmacist and president of the Institute for Safe Medication Practices.
He said more and more pharmacies are mixing IV medications like the ones Courtney is alleged to have tampered with. And he said state pharmacy regulators generally are not trained to monitor those mixtures.
Missouri's pharmacy board has six inspectors who make unannounced visits at pharmacies. But they are responsible for nearly 6,800 pharmacists at 1,550 pharmacies.
The Food and Drug Administration has an enforcement arm, too. But it has just 150 agents nationwide, and they are responsible for regulating drugs, not pharmacies. The 11 agents in Kansas City cover 11 states.
Members of the FDA's Kansas City Office of Criminal Investigations helped run the sting that led to the charges against Courtney. But they got involved only after a drug salesman became suspicious.
Investigators said Eli Lilly salesman Darryl Ashley noticed Courtney wasn't buying as much Gemzar as he was billing to Dr. Verda Hunter, one of several cancer doctors Courtney supplied with IV bags of medication. Hunter alone bought $100,000 per month worth of drugs from Courtney.
The drug salesman contacted Hunter with his suspicions.
Hunter then found an IV bag from Courtney's pharmacy that contained Taxol and had it tested. The bag contained less than one-third as much Taxol as she had prescribed. She notified the FDA, which eventually brought in the FBI.
Hunter worked with investigators to order more chemotherapy treatments from Courtney, which were tested and are now being used in the case against the pharmacist.
While the FDA officers have seen cases where addicted medical workers stole drugs to feed a habit, they could hardly believe what they found in this case, said Larry Sperl, head of the FDA Kansas City criminal-investigation office.
``I think we knew, as soon as this thing really started coming together, that this was a whole different animal than what we've been seeing in these other cases,'' he said.
Cases of pharmacists adulterating drugs are considered rare.
In California, two lawsuits filed earlier this month accuse AIDS doctor George S. Kooshian of Newport Beach of administering saline instead of expensive AIDS medications.
Kooshian has not been charged with any crimes, and he denied the accusation to the Orange County Register. But he also told the paper that he gave his patients solutions of multivitamins when he couldn't procure the AIDS drugs. The state medical board is looking into the matter.
In Grand Rapids, Mich., in 1995, a pediatrician resigned his practice after admitting he gave 649 children bogus vaccinations for polio and measles, mumps and rubella. In that case, a nurse noticed that Dr. James Ledrick's drug supply wasn't depleted enough for the number of vaccinations he was supposedly giving. Ledrick's medical license was suspended for six months.
In 1997, a morphine-addicted doctor in Minnesota was convicted of tampering in 1997 for stealing the drug from patients' IV bags -- while relatives were in the room -- to feed his habit.
Cohen, from the Institute for Safe Medication Practices, said a buddy system for doctors or pharmacists who mix drugs might help prevent mistakes and thievery. If two people supervised each mixture, it would be difficult for either to hold back on the drugs, he said.
Courtney employed two other pharmacists at his pharmacy but told investigators no one else was involved with the drugs he diluted, authorities said.
David Witmer, director of professional practice and scientific affairs at the American Society of Health-System Pharmacists, said he hopes the case does not provoke a rush for more regulation.
``If this were much more prevalent, we would have heard more about it than we have,'' he said.
But Larry D. Sasich, a pharmacist with Public Citizen Health Research Group, said the high cost of drugs might be increasing the temptations for doctors and pharmacists.
``It has only been recently where we've started to think about the fact that some drugs are more expensive than gold, and that there is probably a perverse financial incentive'' to cheat, he said.
Copyright © 2001 Associated Press Information Services, all rights reserved.
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