Diluted Chemotherapy Case 'Mindblowing' to Pharmacists

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Drugstore Shock Diluted Chemotherapy Case 'Mindblowing' to Pharmacists

By Geraldine Sealey

Aug. 17 As if having cancer isn't bad enough, hundreds of patients in Kansas City, Mo., learned this week they may have received diluted chemotherapy drugs from their pharmacist.

MORE ON THIS STORY RELATED STORIES FBI: Druggist Diluted Cancer Drugs Robert R. Courtney, the pharmacist in question, was charged Tuesday with one felony count of misbranding and adulteration of a drug. Prosecutors say Courtney may have diluted expensive cancer drugs for personal gain, filling some prescriptions with only a fraction of what physicians ordered. If intentional dilution did occur, medical experts say the egregious crime would be virtually without precedent. But even if it was just plain old human fallibility that caused the Kansas City chemotherapy debacle, experts say it still would be unthinkable given the range of problems reported so far.

Prosecutors say Courtney "underdosed" prescriptions for the cancer drugs Taxol and Gemzar, dispensing only 1 percent of the drug prescribed in one case.

"It's mindblowing," said Peggy Kuehl, a doctor of pharmacy with the American College of Clinical Pharmacy.

More Than a 'Rip-Off'

Chemotherapy drugs are so potentially toxic and require such care in preparation that they are often mixed in hospitals, clinics or doctor's offices, often in conjunction with a hospital pharmacy. In some instances, though, outside pharmacists, like Courtney, mix the drugs.

Outside pharmacists who dispense intravenous drugs such as chemotherapy treatments, antibiotics or nutritional supplements, usually make such medications their specialty, since they are expensive and difficult to prepare.

Whether prepared inside or outside the hospital, however, all pharmacists must adhere to the same state and federal standards dictating things such as the kind of equipment that should be used and how often it should be sterilized.

But standards sometimes don't dictate what kind of a system should be in place to catch potentially fatal errors.

Typically, experts say, it's safer to have more people involved in the process, rather than one pharmacist taking the order, processing, preparing, labeling, dispensing and billing for it.

"When there's one individual or a small group of individuals involved with the preparation, there's a greater potential for the behavior exhibited in this [Kansas City] case," said John Armitstead, director of pharmacy services at the University of Kentucky Hospital. "It's about more than just 'ripping off' a consumer, it could really put a patient at risk."

Are Standards Severely Lacking?

Indeed, pharmacists and all medical professionals have been sobered by reports of medical errors. A 1999 Institute of Medicine report estimated that mistakes kill 98,000 Americans annually, and medication errors account for a good chunk, researchers found.

Although inconsistent reporting makes good statistics hard to come by, state pharmacy boards have estimated that between 2 percent and 5 percent of the prescriptions filled in 1999 included some sort of error, ranging from misspellings to more consequential mistakes.

One problem facing the pharmacy profession, says pharmacist Michael Cohen of the Institute for Safe Medication Practices, is a "severely lacking" system of standards and oversight. Although states have some guidelines for pharmacies, and though professional organizations have developed rules, he says the standards need to be bolstered.

"What we're not doing is learning what went wrong and making sure information is applied to other situations and making sure there is some oversight," he said.

Tougher guidelines for pharmacists won't help in every situation, of course, especially if a practitioner really wants to work outside the rules.

"It doesn't matter how many checks you have in the system if you don't have a scrupulous provider," said Susan Winckler, group director of policy and advocacy for the American Pharmaceutical Association.

Drug Salesman Alerted Authorities

In the Kansas City case, a salesman for the drug company Eli Lilly and Co. said he noticed Courtney had purchased only a fraction of the drugs his office had ostensibly provided, and alerted authorities. This in itself demonstrates a "check" on pharmacists, said Armitstead of the University of Kentucky. "Unfortunately, it had to be outside the system," he said.

Physicians can help safeguard their patients from unethical pharmacists, Kuehl said, by working with reputable providers and checking them out. "If I were a physician where I was identifying a place to have these certain kinds of drugs put together, I would want to be sure they met the standards I had in mind," she said.

But patients also have a responsibility, Armitstead said. "Choose a reputable pharmacy, with a good reputation. But also you should know your pharmacist as much as you know your physician."

If convicted on one charge, Courtney could face three years in prison and a $250,000 fine. Prosecutors say more charges could follow.


-- Martin Thompson (mthom1927@aol.com), August 17, 2001


Courtney was doing these poor victims a favor. Chemotherapy is euthanazia by the "doctors" who supposedly cure us. I'll bet most of these patients end up leading longer lives as a result.

In case I stepped on any nerves, there is hope in the form of Hulda Clark and "The Cure For All Cancers". Get ahold of her book and stay away from this garbage. They've been experimenting with radiation since 1933. It's time we woke up to the end result.

-- Ken (n4wind@sonic.net), August 17, 2001.

Ken, you are a fool.

-- Frank Franks (love@love.com), August 18, 2001.

This is the saddest thing.. I cannot imagine why anyone, pharmacist or not, would put these patients through this.

-- Tess (webwoman@iamit.com), August 20, 2001.

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