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Hospital, Pharmacy Groups Reassure Patients After Kansas City Scandal

Donna Young

E. Thomas Carey, pharmacy director for Swedish American Hospital of Rockford, Ill., said the arrest of a Kansas City, Mo., pharmacist for allegedly diluting chemotherapy drugs could cause the general public to lose faith in the pharmacy profession.

Carey said that, within days of the arrest, a family member of a patient who was being treated at his hospital’s outpatient oncology clinic asked whether the clinic had ever purchased chemotherapy drugs from the accused pharmacist.

"Even though we are several hundred miles away in Illinois and that pharmacist is in Missouri, people still have questions," Carey said.

Robert R. Courtney, a pharmacist and owner of Research Medical Tower Pharmacy in Kansas City, faces 20 federal felony charges alleging that he tampered, misbranded, and adulterated Gemzar and Taxol, two cancer-fighting drugs marketed by Eli Lilly and Co. of Indianapolis and Bristol-Myers Squibb Co. of New York, respectively.

Courtney has pleaded not guilty to the charges.

Many professional pharmacy and health care organizations, including the American Society of Health-System Pharmacists (ASHP), have released statements condemning Courtney’s alleged actions.

On Aug. 31, Missouri’s Sen. Christopher S. Bond sent a letter to Health and Human Services (HHS) Secretary Tommy G. Thompson questioning whether pharmacists are regulated strictly enough.

In the letter, Bond asked if the federal government should have a larger role in the "policing of the conduct of pharmacists."

"The Courtney case raises troubling questions about the adequacy of state and federal mechanisms used to monitor pharmacists' compliance with all applicable laws," Bond wrote in his letter. "Specifically, we know that had Dr. Courtney's unethical practices not been uncovered by an alert [Lilly] drug salesman, in all likelihood he would have continued to escape detection by regulators. That is unacceptable, regardless of whether the Courtney case is an anomaly or a symptom of a larger problem still awaiting full discovery."

ASHP and eight other pharmacy organizations sent Bond a letter urging him to withdraw his request to Thompson.

The organizations told Bond that they believed his letter to Thompson "unfairly questions pharmacists’ commitment to their patients and the profession."

"The actions of one individual should not be used to question the integrity of one of the nation’s most trusted professions," the pharmacy organizations’ letter said. "This isolated incident of alleged criminal behavior does not support the restructuring of a well-designed state-based regulatory system."

American Swedish’s Carey said the publicity about Courtney, in addition to Bond’s public letter, has caused some patients and family members to be more concerned about chemotherapy and other drug treatments prepared by pharmacists.

Carey said his hospital has taken a proactive approach to address the situation.

"The public doesn’t know about the process of buying from a drug wholesaler," he said. "That’s why it is important for us to tell people. We can explain things to them and show them that their drugs are prepared in a safe way."

Carey said he first made sure the outpatient clinic’s pharmacists and technicians were well-informed about Courtney’s arrest, in case patients had questions.

"You want people to know you are on top of things," he said.

Carey said the outpatient clinic gives patients a brief tour of the pharmacy to reassure them.

"We show them that the bottles are tamper-resistant," he said.

Carey's pharmacy staff also explains to patients that the hospital buys drug products from wholesalers and that the outpatient pharmacy staff, unlike the Kansas City pharmacist, has nothing to do with the billing process.

In addition, Carey said, the outpatient clinic invites patients to watch, through the open half of the pharmacy’s split door, a pharmacist prepare their chemotherapy drugs in the vertical-laminar-airflow hood.

"You want people to feel confident about the care they are receiving," he said.

ASHP’s Executive Vice President Henri R. Manasse, Jr., Ph.D., Sc.D., applauded American Swedish’s pharmacists.

"Our colleagues in Illinois are setting a wonderful national example," he said. "This program is a constructive, positive action to affirm with the general public and hospital patients that pharmacists adhere to their public trust by applying their skills and judgments to patient care needs."

Since Courtney’s arrest in August, federal investigators have uncovered evidence that Courtney may have also diluted four other drug products: Bristol-Myers’ Platinol and Paraplatin, Procrit from Ortho Biotech Products L.P. of Raritan, N.J., and tissue plasminogen activator, or TPA, a medication that fights blood clots during ophthalmic surgery.

A trial, originally scheduled for Oct. 1, has been postponed until Feb. 4 to give Courtney’s attorneys more time to build his defense.

More than 50 civil lawsuits have been filed against Courtney and his pharmacy in Jackson County Circuit Court. Some civil suits have also been filed against Eli Lilly.

A federal judge has slapped a lien on Courtney’s assets, estimated to be more than $10 million.

The FBI is also looking into allegations of billing fraud by Courtney.