When People Fail

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Handout photo of Lance Armstrong speaking with Oprah Winfrey in AustinI am personally struggling with two pieces of information today.  The first is that Lance Armstrong has come clean with Oprah about his doping scandal.  I had hoped that it was all fabricated by those who were jealous, but alas he is guilty.  I cannot even understand why the leagues (baseball, biking etc...) don't realize that the cost of winning is at ALL costs.  Why not just make these substances all legal and do away with that aspect of what we are capable of doing on our own.  This is 2013.  I would say at this point most sports has seen their very best without enhancement.  What is left?  Enhancement. I know that seems bizarre for a pharmacist to say publicly that doping for sports should be made legal, but that is what I am saying.  As long as it stays illegal, the coaches and trainers and others involved in making the best of the best will go at all lengths to find substances that are not yet known or tested and continue to dope.  It is inevitable.

The other piece of information that I am struggling with today is that a former classmate in pharmacy school (who I will call Ed for his own privacy) has made a deal in pleading guilty in a case that I have had a hard time understanding.

You see, Ed was the type of student in our class who was a man of character.  He was one of the good guys.  I believe he was already married and was in the pharmacy fraternity that was more studious and less partying.  You can imagine that I was in the partying one and you would imagine right.  Ed has a large family now; he has small children and a wife that need him.

Ed has had some legal trouble in which there was some sort of federal charge brought against him for distributing controlled substance (Oxycontin) from his pharmacy.  I don't know how this whole thing began, but apparently it began fairly innocent enough with perhaps one bad decision or perhaps another part of the story that I do not know.  Maybe it was driven by needing money.  Perhaps it was driven by a bad decision further snowballing into extortion by some drug addicted criminals.

Either way, Ed is going to likely go to prison for around five years or so, and my heart breaks for him.

I know that it is easy for many to condemn a man like Lance Armstrong for doping but the bigger offense being the lies he told over the years and nastiness that ensued.  He threatened, sued and was a bully for the most part.  He "beat" cancer of the brain metastasized from testicular cancer, and he founded Livestrong.  There was good to the fame and notoriety even if he came by it by cheating.  Does the means justify the end?  Sometimes?

Fifteen years ago I would have looked at both men making bad decisions and would have spewed my opinion, and it would have been quite judgmental.  I tend to not do that as much because the situation is much more complicated the older I get.  You see, people fail.  People are human - even the most trusted professional, the pharmacist.  The moment that I believe that I am infallible of filling will be the moment where I am the most vulnerable.  We must always strive to do our best.  Do not compromise even for a moment the integrity and good name you have.  It is all you have in the way of public opinion, and in the case of Ed, I was a little saddened to read that he has struck a deal with the government about pleading guilty to one count and going to prison.  He will be sentenced right before this summer, and I dread it for him and his sweet wife and children.

I do hope for a silver lining for Lance Armstrong somehow.  I hope that he is able to look back at his life and see his own shortcomings and how they shaped him into something even better.  Yes, he made a mistake and turned that mistake into a snowball of lies and more denials that took years for him to admit, but there are good things that he has done.

My friend made a mistake and is going to pay the consequence for it by missing five years of his children's lives.  Both of them still are men I can admire for good things in the past and I hope even better things in the future.  Somehow.

 

 

Who is David Matthew Kwiatkowski?

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Exeter, NH – Exeter Hospital worker David Matthew Kwiatkowski, who officials say had hepatitis C and spread the disease to 30 unsuspecting patients by stealing drugs, has been arrested, the U.S. Attorney's office in New Hampshire announced Thursday. Kwiatkowsi, 32, of Exeter, was arrested this morning at a hospital in Massachusetts, where he's receiving treatment for hepatitis C. He's charged with fraud and tampering.

He faces up to 24 years in prison and a $250,000 fine.

That is it?  A life sentence would be more appropriate.  Let us delve into the world which is Hepatitis C.  What future will these patients and any others that he so selfishly infected face?

Thomas Wharton, MD, FACC, medical director of the Cardiac Catheterization Unit at Exeter Hospital, now views Kwiatkowski as “the ultimate con artist and an extremely good cardiac technologist who pulled the wool over everyone's eyes.”

Of the isolated incidents that fellow Cardiac Catheterization Unit employees began reporting in the spring, Dr. Wharton said, “David had stories for everything that pulled at your heart-strings and we had no reason to disbelieve him. David claimed to have several important medical conditions, and we had no reason to challenge this. The day he reportedly arrived to work with red eyes he told us his aunt had died the night before and he had been up all night crying.”

And the kicker really is his response to investigators about the people he spread the virus to:

"You know, I'm more concerned about myself, my own well being," he told investigators. "That's all I'm really concerned about and I've learned here to just worry about myself and that's all I really care about now."

From http://www.epidemic.org:

Although few prospective long-term survival and health care cost studies are available for hepatitis C, it has been possible to estimate the life-long economic impact of the disease for both the individual patient and for the U.S. population with chronic hepatitis B. Lifetime health care costs for a patient with chronic hepatitis B has been estimated at $65,000 in the absence of liver transplantation. For the 150,000 HBV carriers with significant liver damage, the lifetime health care costs in the U.S. have been estimated to be $9 billion. Assuming an estimated survival of 25 years, the annual health care costs for the affected U.S. population with chronic hepatitis B is $360 million. Based on the same economic analysis, treatment of chronic hepatitis B with interferon is projected to increase life expectancy by about three years and cut the total health care costs.

Hepatitis C can only represent a far greater economic cost. While it infects about 3 and a half more times as many people in the United States than does hepatitis B, more than 80% of hepatitis C patients will develop chronic liver disease, as compared to only 20% of hepatitis B patients. Limited data suggest that 15-20% of those with chronic hepatitis C will develop cirrhosis within a five-year period, and as many as 25% may have cirrhosis by 10-20 years. The risk of developing liver cancer is uncertain, but may approach or exceed 1% during the first 20 years of infection and increase afterwards. Hepatitis C is responsible for about one-third of all liver transplants in the United States.

Approximately 1,000 patients are transplanted each year for liver disease due to hepatitis C. With the cost per liver transplantation in the range of $280,000 for one year, liver transplantation for hepatitis C alone reaches a cost of nearly $300 million per year.

Moreover, the average lifetime cost for hepatitis C, in the absence of liver transplant, has been estimated to be about $100,000 for individual patients. Assuming that 80% of the 4.5 million Americans believed to be infected develop chronic liver disease, the total lifetime cost for this group (3.6 million) will be a staggering $360 billion in today's dollars. Assuming an estimated survival of 40 years, the annual health care costs for the affected U.S. population with chronic hepatitis C may be as high as $9 billion.

It would be prudent to consider that every single person that he has infected would at the VERY least receive $100,000 up front PLUS the cost of transplant and the cost of the emotional toll.  He should never be able to walk in society again and spend the rest of his time working to pay this debt.

I also believe that the hospital should cover the rest of the cost considering the signs were there for him being under the influence.  All it would have taken would be ONE person, ONE coworker, ONE physician to take the chance and get this guy tested.  Also, pharmacists should have a bigger role in a cath lab like this to prevent nurses and staff from having such access to be able to hide something like this.  I'm just appalled at this man's evil behavior coupled with the lack of safe policy at the hospital(s) in question.

This is just my opinion.

Related articles

Oxycontin Reformulation and the Heroin Effect

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According to multiple news agencies and a letter published by New England Journal of Medicine, former Oxycontin addicts are moving over to a cheaper readily available illegal substance to get high -- heroin.

Effect of Abuse-Deterrent Formulation of OxyContin

N Engl J Med 2012; 367:187-189July 12, 2012

Article

TO THE EDITOR:

In August 2010, an abuse-deterrent formulation of the widely abused prescription opioid OxyContin was introduced. The intent was to make OxyContin more difficult to solubilize or crush, thus discouraging abuse through injection and inhalation. We examined the effect of the abuse-deterrent formulation on the abuse of OxyContin and other opioids.

Data were collected quarterly from July 1, 2009, through March 31, 2012, with the use of self-administered surveys that were completed anonymously by independent cohorts of 2566 patients with opioid dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders,4th edition, who were entering treatment programs around the United States and for whom a prescription opioid was the primary drug of abuse (i.e., heroin use was acceptable but could not be the patient's primary drug). Of these patients, 103 agreed to online or telephone interviews to gather qualitative information in order to amplify and interpret findings from the structured national survey.

Effect of Abuse-Deterrent OxyContin., the selection of OxyContin as a primary drug of abuse decreased from 35.6% of respondents before the release of the abuse-deterrent formulation to just 12.8% 21 months later (P<0.001). Simultaneously, selection of hydrocodone and other oxycodone agents increased slightly, whereas for other opioids, including high-potency fentanyl and hydromorphone, selection rose markedly, from 20.1% to 32.3% (P=0.005). Of all opioids used to “get high in the past 30 days at least once” OxyContin fell from 47.4% of respondents to 30.0% (P<0.001), whereas heroin use nearly doubled.

Interviews with patients who abused both formulations of OxyContin indicated a unanimous preference for the older version. Although 24% found a way to defeat the tamper-resistant properties of the abuse-deterrent formulation, 66% indicated a switch to another opioid, with “heroin” the most common response. These changes appear to be causally linked, as typified by one response: “Most people that I know don't use OxyContin to get high anymore. They have moved on to heroin [because] it is easier to use, much cheaper, and easily available.” It is important to note that there was no evidence that OxyContin abusers ceased their drug abuse as a result of the abuse-deterrent formulation. Rather, it appears that they simply shifted their drug of choice.

Our data show that an abuse-deterrent formulation successfully reduced abuse of a specific drug but also generated an unanticipated outcome: replacement of the abuse-deterrent formulation with alternative opioid medications and heroin, a drug that may pose a much greater overall risk to public health than OxyContin. Thus, abuse-deterrent formulations may not be the “magic bullets” that many hoped they would be in solving the growing problem of opioid abuse.

Theodore J. Cicero, Ph.D. Matthew S. Ellis, M.P.E. Washington University in St. Louis, St. Louis, MO cicerot@wustl.edu

Hilary L. Surratt, Ph.D. Nova Southeastern University, Coral Gables, FL

Related articles

Crime and Pharmacy

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I have been visiting this topic over and over... both on the internet searching around, in the local paper which shouts of a 40-something year old woman who is robbing local pharmacies (with a gun), memories from my own past of being held up at gunpoint, and discussing with a retail pharmacist this past weekend in regards to how unsafe it is. (HERE at least). An article quoted in full:

Local Pharmacies React To Rise In Crime As Demand For Certain Prescription Drugs Escalates

In light of the recent shooting pharmacies are on high alert.

The shooting that took place Sunday morning at Haven Drugs in Medford has caused many local pharmacists to focus on the alarming statistics that crime in pharmacies across the region is skyrocketing, as the demand for certain prescription drugs, namely strong opiate painkillers, is increasing.

Michael Hushin, owner and manager of Lakeland Pharmacy in Ronkonkoma said he has already been robbed at gunpoint about a year and a half ago. He now has controlled substances locked away, has obtained a pistol permit and keeps a baseball bat behind the counter.

The armed robber had come to Lakeland Pharmacy for 80mg Oxycodone.

"The biggest strength they make. It's the major score right off the bat," said Hushin.

He was alarmed about the recent shooting which seemed to fly in the face of all reason.

"This particular case was extremely different, there was absolutely no provocation. I don't even know how you protect against that," Hushin said.

When Lakeland Pharmacy was robbed, a man handed over a note, and then came behind the counter. Hushin said, "He was armed. He wanted one thing; and we tried to give him what he wanted."

Store customer, Jessica Greig, 18, said, "I'm going into the medical field. I would never work in a pharmacy now."

She is also more on guard as a customer.

"If I saw someone sketchy, I would definitely run out of the store," Greig said.

According to Hushin, some stores are considering not stocking certain medications.

"I don't know if I'd go that far. It's not fair to the people who need the medicines," he said.

Hushin said this is the second or third death of a pharmacist that he knows of occurring in the last six months, in the New York area.

"They were all robberies. Some of them very brazen, all related to pharmacy theft for opiates."

Slater Pharmacy's pharmacist Martin Robinson said that while they have never experienced a hold-up in their store, he was still shaken up.

"People don't realize that just by going to work each day your life is in danger," he said. "We're dealing with very desperate people."

The store has some basic precautionary measures in place such as surveillance cameras, asking customers to remove hats and sunglasses, and is considering not stocking certain medications.

"It's hard to be helpful, and deny people at the same time," Robinson said.

"My husband gave me a kiss goodbye because he knew I was coming to the drugstore," said Debbie Breithaupt, a longtime customer of Slater Pharmacy. "It hit home. It's just another place they made us feel unsafe."

Rick Ammirati, owner of Friendly Drugs, said he hasn't experienced any increase in criminal activity, or heard of anything unusual in the area. He does, however, have friends in the industry that have had robberies.

"It just puts you on high alert to take a second look at everybody that comes in now," said Ammirati. "It's heightened awareness."

 

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There IS a rise in pharmacy crime. It IS riskier to be a retail pharmacist today than thirty years ago.

Gunned Down

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There they are. The two arrested for the horrific pharmacy murders. Apparently the female here had an oxycodone habit that her husband was trying to feed. This is the face of the people that retail pharmacists across our country has to face day in and day out. It's a matter of time before the next one flips out and does the same thing.

Here are three of the four victims. I hope that both of these horrible criminals get exactly what they deserve. However, the accused have more rights than these three victims had killed at point blank range.

A pharmacist, a mom of three getting ready for her wedding, and a lady graduating from high school just days later killed FOR NO REASON. (also not pictured an elderly man was gunned down as well).

 

The Oxycodone Addict

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Pharmacists have all heard of the oxycodone addict coming in their pharmacy and demanding their drug of choice at gunpoint. I have been removed from retail for many years but have had the firsthand knowledge through close colleagues and numerous reports of pharmacies no longer stocking oxycontin, oxycodone, and other narcotics frequently sought out by addicts. On Father's Day, this past Sunday, four people died in a corner drugstore.

Raymond Ferguson, 45, a pharmacist opened the store with a teen pharmacy technician, Jennifer Neijia, 17. Jennifer volunteered to work for an adult tech who had kids and wanted to celebrate Father's Day. Two customers were also killed senselessly, 33 year old Jamie Taccetta who was the mother of two daughters and was about to celebrate her own wedding and Bryon Sheffield, 71.

The problem with the addict is that all thought processes change. The drug fiend who massacred four people at the pharmacy coldly executed them one by one at close range before filling a backpack with pills and strolling away.

It is safe to say that the corner pharmacy is definitely a dangerous place to be.

Criminal Charges Pressed Against a Healthcare Provider. A First.

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This case has really bothered me.  For the first time that I can find, a pharmacist has been criminally charged in the death of a child in Ohio.  Eric Cropp, a pharmacist, made a fatal error when checking a chemotherapy solution for Emily Jerry.  CLEVELAND — Former pharmacist Eric Cropp was found guilty of involuntary manslaughter Wednesday in the death of a 2-year-old girl killed by a lethal injection of a salt solution during a cancer treatment.

Cropp, 40, of Bay Village, pleaded no contest to the charge at a hearing in Cuyahoga County Common Pleas Court. Judge Brian Corrigan will sentence Cropp on July 17. The maximum sentence is five years in prison and a $10,000 fine.

Prosecutors dropped a reckless homicide charge as part of a plea deal.

Cropp was the supervising pharmacist at Rainbow Babies and Children's Hospital on Feb. 26, 2006, when pharmacy technician Katie Dudash prepared a chemotherapy solution for Emily Jerry that was 23 percent salt. The formula called for a saline base of less than 1 percent.

The child died on March 1 after slipping into a coma.

As the supervising pharmacist, Cropp's duty was to inspect and approve all work prepared by the technicians before it was given to patients. Dudash agreed to testify against Cropp and was never charged.

The Ohio Board of Pharmacy stripped Cropp of his license in 2007. Since then, he has been unable to find steady employment, his attorney Richard Lillie said recently. Cropp has worked odd jobs, cleaning boats and walking dogs.

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Cropp served 6 months in jail, paid fines, has tons of community service hours, lost his license for life, etc...

I realize that this case is very sad in that a little girl has died.  But I have read this case inside and out and it's fairly certain that the hospital hung Cropp out to dry.  The hospital settled for millions with the family.  The mother was on a witch hunt for the pharmacist to pay.  The tech faced NO CHARGES AT ALL.  This is unreal!!  First of all, we are humans.  Humans make mistakes.  I get nervous thinking about cases and situations like this and I look at what happened and wonder "Could this happen to me as a pharmacist?"

Eric's mistakes were that he didn't take a break that day.  He had a friend bring him lunch.  He was way behind because of a printer problem.  The hospital IV setup was not condusive to safety.  There was a bag of NS laying near  where the compound was finished.  WHO in the world makes NS from hypertonic?????  The tech was planning her wedding.  She gets to resume her life with no issues at all.

Diprivan and the Death of Michael Jackson

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Milk of amnesia, propofol, diprivan, whatever you want to label it, diprivan has always been a medication that I put in the category of a medication that definitely needs hospital or long-term care support when administrating. Now because of the latest error a physician made in the case of Michael Jackson, the drug is propelled into the spotlight. Just recently:

Propofol: Limited Recall Due to Elevated Endotoxin Levels − July 2009

Teva Pharmaceuticals USA has announced a voluntary recall of certain lots of propofol injectable emulsion 10 mg/mL 100 mL vials. The lots identified are being recalled due to elevated endotoxin levels in some of the vials. Teva has received reports of 41 propofol treated patients experiencing postoperative fever, chills, and other flu-like symptoms; most cases reported appeared to be self-limiting. Possible adverse effects associated with elevated endotoxin exposure include fever, chills, and rigors. High endotoxin level exposure may be associated with more serious adverse effects including disseminated intravascular coagulopathy, acute respiratory distress syndrome, and death.

But, that only included certain lots. Sounds scary, huh?

High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Um, no brainer. It's a medication that is an intravenous infusion and has several pharmacological purposes includng induction of anesthesia in patients ≥3 years of age; maintenance of anesthesia in patients >2 months of age; in adults, for monitored anesthesia care sedation during procedures; sedation in intubated, mechanically-ventilated ICU patients.

And straight from the books:

Concerns related to adverse effects:

• Anaphylaxis/hypersensitivity reactions: May rarely cause hypersensitivity, anaphylaxis, anaphylactoid reactions, angioedema, bronchospasm, and erythema; medications for the treatment of hypersensitivity reactions should be available for immediate use.

• Hypertriglyceridemia: Because propofol is formulated within a 10% fat emulsion, hypertriglyceridemia is an expected side effect. Patients who develop hypertriglyceridemia (eg, >500 mg/dL) are at risk of developing pancreatitis. Serum triglyceride levels should be obtained prior to initiation of therapy and every 3-7 days thereafter. Monitoring of serum triglycerides should especially be considered with therapy >48 hours with doses exceeding 50 mcg/kg/minute (Devlin, 2005). An alternative sedative agent should be employed if significant hypertriglyceridemia occurs. Use with caution in patients with preexisting hyperlipidemia as evidenced by increased serum triglyceride levels or serum turbidity.

• Hypotension: The major cardiovascular effect of propofol is hypotension especially if patient is hypovolemic or if bolus dosing is used. Hypotension may be substantial with a reduction in mean arterial pressure occasionally exceeding 30%. Use with caution in patients who are hemodynamically unstable, hypovolemic, or have abnormally low vascular tone (eg, sepsis).

• Injection-site reaction: Transient local pain may occur during I.V. injection; lidocaine 1% solution may be administered prior to administration or may be added to propofol immediately prior to administration to reduce pain associated with injection (see Administration).

• Myoclonus: Perioperative myoclonus (eg, convulsions and opisthotonos) has occurred with administration.

• Propofol-related infusion syndrome (PRIS): PRIS is a serious side effect with a high mortality rate characterized by dysrhythmia (eg, bradycardia or tachycardia), heart failure, hyperkalemia, lipemia, metabolic acidosis, and/or rhabdomyolysis or myoglobinuria with subsequent renal failure. Risk factors include poor oxygen delivery, sepsis, serious cerebral injury, and the administration of high doses of propofol (usually doses >83 mcg/kg/minute or >5 mg/kg/hour for >48 hours), but has also been reported following large dose, short-term infusions during surgical anesthesia. The onset of the syndrome is rapid, occurring within 4 days of initiation. The mechanism of the syndrome has yet to be determined. Alternate sedative therapy should be considered for patients with escalating doses of vasopressors or inotropes, when cardiac failure occurs during high-dose propofol infusion, when metabolic acidosis is observed, or in whom lengthy and/or high-dose sedation is needed (Jacobi, 2002; Corbett, 2008).

Sound familiar???

Two Pharmacists Convicted

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My question is this:  How did they get away with it for so long???

By Nick Madigan

Sun reporter

August 1, 2008

After a seven-week trial, two pharmacists accused of selling almost 10 million addictive painkillers illegally over the Internet were convicted yesterday in federal court in Baltimore of that offense and several others.

Steven Abiodun Sodipo, 51, of Forest Hill and Callixtus Onigbo Nwaehiri, 49, of Jarrettsville were found guilty of selling 9,936,075 units of hydrocodone online using phony prescriptions; conspiracy to launder money; engaging in transactions involving the proceeds of drug sales; and filing false tax returns.

Sodipo and Nwaehiri, who face maximum sentences of 70 years in prison, owned and operated Newcare Pharmacy in the 400 block of Sinclair Lane in Baltimore, a business they founded in 1993 that initially specialized in delivering medications and medical supplies to nursing homes and other assisted-living facilities. There was no walk-in service as in traditional, drugstore-based pharmacies.

Prosecutors said that beginning in 2004, the defendants joined a "nationwide conspiracy" to illegally sell hydrocodone over the Internet to anyone with a valid credit card. They engaged in agreements with Web site operators to fill prescriptions e-mailed to them that were signed by a small group of doctors. The doctors, who never saw or spoke to customers, routinely authorized the prescriptions, which were then wired to Newcare for filling and shipment, prosecutors said. In return, Newcare was paid $20 for each prescription it filled and shipped.

"Prescription drug abuse is a growing crisis in Maryland and throughout the nation, and it is one of our most important drug enforcement challenges," Maryland U.S. Attorney Rod J. Rosenstein said after the verdicts. "Many people wrongly assume that prescription drugs are safe. The truth is that using any drugs without proper medical supervision can result in addiction, injury or death."

Carl J. Kotowski, an assistant special agent in charge of the Drug Enforcement Administration's Baltimore office, said the investigation of Newcare "sends an instant message to cybercriminals that the Internet is not their safe house."

Evidence presented at trial showed that Sodipo and Nwaehiri continued to sell large quantities of hydrocodone even while aware that some of their customers were addicts.

The government is seeking the forfeiture of $20 million, the gross proceeds of the sales of hydrocodone from January 2005 to October 2006, when DEA agents raided Newcare's 55,000-square-foot facility and arrested its owners. More than 50 employees of the pharmacy lost their jobs. The government also intends to seize the Newcare facility and its contents, and the homes, bank accounts and motor vehicles of the defendants.

Chief U.S. District Judge Benson E. Legg set sentencing of the two men for Oct. 21.

A co-defendant, Ahmed Alhaji Abdulrazaaq, 49, of Forest Hill was charged with conspiracy to defraud the IRS and is scheduled to go to trial Sept. 2.

nick.madigan@baltsun.com

Copyright © 2008, The Baltimore Sun