GOVERNMENT and LAW

Prosecutor to pharmacists: Keep your nose clean

No pharmacist likes to be hauled before his or her state authorities to face disciplinary charges. To help pharmacists avoid that possibility, a New York prosecutor gave pharmacists in the state some sound advice recently on how to stay out of trouble at a legal seminar sponsored by the Arnold & Marie Schwartz College of Pharmacy & Health Sciences.

According to Michael Gary Hilf, deputy director of prosecutions at the Office of Professional Discipline (OPD), his group is in charge of investigating cases against pharmacists. In 2002, 395 cases were brought against pharmacists or pharmacies in New York based on complaints from the public, Hilf reported. Out of this total, 85% were disposed of after an informal settlement. Only 51 cases, or fewer than one in seven, moved on to a hearing or prosecution.

If pharmacists don't want to put their license on the line, they should avoid engaging in intentional or negligent misconduct, Hilf advised the pharmacists in attendance. Intentional misconduct involves being convicted of a crime, even if it's wholly unrelated to pharmacy, such as drunken driving or shoplifting. Under New York State law, this is considered professional misconduct. Pharmacists should also avoid committing crimes related to the practice of pharmacy, such as selling an Rx-required drug without a prescription or fraudulently billing Medicaid for prescription drugs. This type of conduct is likely to bring on especially tough discipline, he cautioned.

Many cases OPD has seen involve negligent misconduct, such as dispensing the wrong drug, wrong strength, or wrong directions for use, Hilf continued. While many of these dispensing errors have been minor in nature, some have caused considerable harm. For instance, he said he's personally prosecuted a case against a hospital pharmacist who dispensed cisplatin, instead of carboplatin, to a patient who died as a result, and another case against a pharmacist who dispensed chlorpropamide, instead of chlorpromazine, to a mother of seven, who remains in a coma five years later.

"If you, as a result of carelessness, committed a dispensing error that kills or seriously injures a patient, you will have to live with the knowledge of the harm you caused," Hilf warned darkly. "For most people, that would be more devastating than anything OPD or a plaintiff's lawyer does to you."

To help pharmacists minimize their risk of misconduct by negligence, Hilf urged them to take the following tried-and-true steps:

• If they can't read a prescriber's handwriting, don't guess. "You should never fill a prescription until you are absolutely certain of what is being prescribed," he admonished.

• Use patient counseling as a tool to catch mistakes before a drug leaves the pharmacy. Don't consider counseling a nuisance.

• Be very careful when dispensing drugs with similar sounding names.

• The same holds true for dispensing drugs where a wrong dosage can cause severe harm. If you don't know what the appropriate dosage range is for a patient of a certain age, "you have no business dispensing that drug until you get that information," he stressed.

• Develop strategies to prevent and catch mistakes. This includes brainstorming with co-workers on how to improve patient safety and setting up a system for continuous quality improvement.

Finally, Hilf said that the National Coordinating Council for Medication Error Reporting and Prevention came out with recommendations for avoiding dispensing errors in 1999. These recommendations are a good place to start, he said. "A little time invested in this endeavor can yield great dividends. Not only will you increase your chances of not having to see me, but you just might prevent a needless death," he told the audience.

Asked by a pharmacist in the audience why the state sometimes metes out different punishment for similar misconduct, Hilf explained that, while authorities strive for consistency in penalties, no two cases are exactly alike. OPD looks at the whole constellation of circumstances. For instance, the conduct might be the same in two cases, but the harm done might be different. Also, the presence or absence of a prior disciplinary record is taken into account. A pharmacist who has never been disciplined previously might get a lesser penalty than someone who was previously censured, he pointed out.

The prosecutor added that penalties are reviewed by a number of people before a settlement is finalized. In fact, there are more levels of scrutiny an OPD disciplinary case must undergo on the way to a settlement than a homicide case in the state, Hilf claimed. The goal is to protect the public on the one hand and to be fair to defendants on the other.

Judy Chi

 

Judy Chi. Prosecutor to pharmacists: Keep your nose clean. Drug Topics Dec. 8, 2003;147:78.