NAPLEX is Suspended

Prof. accused of sharing licensure exam questionsQuality of University not in doubt KRISTEN COULTER

Issue date: 8/30/07 Section: News

Shirley Zhang, a graduate student from China studying biochemical sciences, walks past the Pharmacy Building located on South Campus.

A University pharmacy professor is a defendant in a federal court case, in which he is accused of collecting and disseminating pharmacy test questions to students, according to court documents obtained by The Red & Black.

The National Association of Boards of Pharmacy filed the case Aug. 3 against the Board of Regents and Flynn Warren Jr., citing copyright infringement, misappropriation of trade secrets and breach of contract, according to the documents.

NABP has investigated Warren twice for these allegations.

The North American Pharmacist Licensure Examination and Georgia Multistate Pharmacy Jurisprudence Examination are tests required to obtain a license to practice pharmacy. The NAPLEX is used by all 50 states’ boards of pharmacy, and the MPJE “combines federal and state specific law items to serve as the state law examination in 46 participating jurisdictions,” according to a NABP news release.

At an Aug. 23 meeting, the executive committee of NABP decided to suspend all administrations of the NAPLEX and the Georgia MPJE beginning Aug. 25 and will not administer the test nationwide.

NABF said in the news release it has not decided when to reinstate the test.

“I cannot comment on this, given the current investigation,” said University Provost Arnett Mace Wednesday afternoon.

Warren, who was reached at his home Wednesday evening, also refused to comment.

The College of Pharmacy referred calls to Tom Jackson, the associate vice president for public affairs. Jackson wrote Wednesday in an e-mail, “parties have been ordered by the court not to comment on the matter while it is in litigation.”

While he would not comment on the investigation, George Francisco, associate dean of the College of Pharmacy, said Warren has taught the board review course at the University “for several years.” Francisco said the class lasts three days and is available to both University pharmacy students and students at other institutions.

Warren is accused of copyright infringement because NABP owns the copyrights on the exam questions. Court papers say he asked students to memorize NAPLEX test questions and share them with him. He collected the tests’ contents and created a review packet.

Warren is faced with these accusations because he was never “granted a license … to copy, sell, distribute, prepare derivative works from, or otherwise offered to transfer the ownership of the copyrights of the NABP Examination Questions, to which NABP has exclusive rights,” the court papers read.

Warren is accused of misappropriation of trade secrets because: “the NABP Examination Questions are original lists of questions containing technical information used for evaluating the competency of a candidate in the field of pharmacy,” and the questions “derive economic and evaluative value from not being generally known and not being readily ascertainable by proper means,” according to the documents.

The breach of contract charge stems from a 1995 settlement agreement, in which Warren and the University said they will “cease and desist for profit or otherwise from all past, present and future copying, transcribing or other infringing use of NABP copyrighted materials, including but not limited to patient profiles, sample questions, or other copyrighted information.”

Francisco said he was unaware of the 1995 settlement, and the pharmacy school was not monitoring Warren’s classes.

Last year, the BOR offered to pay $40 million for an addition to the College of Pharmacy.

Professors at other schools exposed exam study guide

According to a biography on the University’s Web site, Warren has been a pharmacy faculty member since 1985. Before his July 1 retirement, he was a clinical professor and the college’s assistant dean for student affairs.

Though he retired last month, Warren still is teaching elective classes for the pharmacy school, Francisco said.

This case arose after Warren offered an annual exam review course at Samford University.

Alan Ray Spies, an assistant pharmacy professor at Samford, said in an affidavit that he learned Warren was giving NAPLEX questions to students. Spies said he first found out this information in May 2007.

“Specifically, I learned that Mr. Warren’s course materials include, among others, a series of questions, some 2,700 in number, that appear to be very similar, if not verbatim, to questions asked on the NAPLEX,” Spies said in the affidavit.

Spies said he talked with some of his students about Warren’s course in the affidavit.

“It soon became apparent to me that individuals who had just taken the exam were sending Mr. Warren questions which he in turn was forwarding to students who had not yet taken the NAPLEX.”

Spies said he sent the information he found in an e-mail to Steven Pray, a pharmacy professor at Southwestern Oklahoma State University.

In his affidavit, Pray discussed his view of the importance of exam security for the NAPLEX.

“The knowledge base required to become a competent pharmacist is vast, taught via hundreds of hours of lectures, laboratories, and practical experiences,” Pray said.

In the affidavit, Pray also discussed his thoughts about the extensive consequences for the exam if the questions have been compromised.

“A loss of hundreds or thousands of items, as it appears, has occurred through the activities of Mr. Warren, will force NABP to endure a loss of millions of dollars and will necessitate a radical overhauling of the examination pool,” he said. “If this is required, the nation’s pharmacy graduates cannot be licensed until a new, uncompromised NAPLEX can be created.”

As he further researched the issue, Pray said in the affidavit that he found an online forum where students discussed Warren’s course.

“This Web site also discussed an individual named ‘Flynn,’ who offered a review course and notes on passing the NAPLEX,” Pray said in the document. “One correspondent on the Web site suggested that prospective examinees review the comments sent to ‘Flynn’ by other students, and another provided his address at the University of Georgia.”

Pray declined Wednesday to speak for attribution about the case with The Red & Black.

Professionals feared news would ‘impair confidence’

According to court documents, Pray sent the information to Carmen Catizone, executive director of NBAP.

In his affidavit, Catizone said Kerri Hochgesang, a lawyer for NABP, bought Warren’s course materials on July 31. In her affidavit, she stated, “a true and correct copy of my payment receipt from the ‘UGA Pharmacy Cont ED, Pharmacy Building’ for the course materials” was given to her for $100.

According to Catizone, the materials contained at least three PDF files. On the NAPLEX REVIEW 2007 disc included in the materials, the files were labeled “NAPLEX MATERIAL PART 2, 2006 INFO FOR NAPLEX, and NAPLEX SAMPLE TEST W ANSWERS.”

Catizone reported his analysis of this material “revealed at least 633 ’sample’ questions contained in Warren’s ‘review course’ and/or were made available by Mr. Warren to candidates who gave him their e-mail addresses.”

He also discussed his concerns about the value of the test if the allegations against Warren are true.

“The extent of the forgoing breach in the confidentiality of NAPLEX exam questions calls into serious question the integrity of the exam,” Catizone said in the affidavit.

Efforts to reach Catizone Wednesday were unsuccessful.

According to an Aug. 6 NABP news release, “United States’ Marshals seized materials and computers from the University of Georgia College of Pharmacy and the offices and home of Flynn Warren, Jr.”

“NABP is disappointed and appalled that the

public trust and health were victimized, the security of the NAPLEX and MPJE breached, and the integrity of the licensure process compromised,” Catizone said in the news release.

On Aug. 3, NABP motioned to file the case under seal, citing potential public panic as a result of the case.

“If the facts of this case are covered in the media or are otherwise publicly available, there is a significant chance that the confidence of the general public in pharmacists and the dispensation of pharmaceuticals will be impaired,” NABP stated in the document.

“This case involved copyright infringement and misappropriation of trade secrets in highly confidential testing materials used in the licensure of pharmacists in many jurisdictions, and reproduction of the testing materials is required in order for Plaintiff to prove its case. Making this information publicly available will further compromise the licensure of pharmacists.”

Warren filed a motion to stay Aug. 21, citing a lack of subject matter jurisdiction.

On Aug. 27, the court “provided the parties with a limited opportunity to conduct discovery related solely to the jurisdiction issue,” according to court documents.

The court also stated, “there have been no final factual determinations by the court and no findings of liability on behalf of any defendant. Furthermore, the court has made no findings that would question the quality of education provided by the University of Georgia College of Pharmacy.”

- Alexis Garrobo, Juanita Cousins and Brian Hughes contributed to this report.

Magic Mouthwash (the vague term for a concoction of ANYTHING)

When I worked in retail pharmacy, a physician would write a prescription for "Magic Mouthwash" and the patient would hand over the prescription with this look of "magic."  This special blend of WHATEVER would be the cureall for their sore mouth and throat caused by thrush or radiation or any other mouth/throat pain condition.  The physician rarely would include what he/she "thought" to be their special recipe.  So, we would have to call and clarify. "What would Dr. Doe like in his magic mouthwash?"  I would ask simply.

"Magic Mouthwash?"  asks the nurse, "I don't know.  What do you normally put in it?"

Sigh.  "Well we could start with diphenhydramine, lidocaine, and nystatin all at a 1:1:1 ratio or we could do tetracycline and throw in some mylanta with the formerly mentioned ingredients at all different ratios.  There are probably a 100 different magic mouthwashes out there.  What is the doctor treating?"

And it would end up that I could pick whatever I wanted.  That made me think... hmmm  placebo effect.

So what exactly should you put in Magic Mouthwash?

The usual concoction contains equal amounts of viscous lidocaine and diphenhydramine for analgesia...and Maalox or a similar antacid to enhance coating of the ingredients in the mouth.  Some also include nystatin to prevent or treat fungal growth...a corticosteroid to reduce inflammation...or tetracycline to prevent secondary bacterial infections.

 

Who knows if this stuff even works and is worth the money since we pharmacists usually tack on a compounding fee.  I say get a prescription for lidocaine viscous and buy your own benadryl solution and mylanta and make your own... for less.

Teamwork and Positive Attitude!!!

There was this cheery orientation video that we all had to watch with the rest of the newbies during the Human Resources' led introduction. I cannot remember the exact name of it, but it had phrases come across the screen of what staff members should NOT say to other members of the staff or patients in the hospital. Rather than: "No. I don't know." Say: "No... but let me find out for you."

There were twenty or more of them, and oh... what a perfect world it seemed for that 10 minutes of listening to those positive and helpful statements. In the real world, I remember the first three weeks of work. I heard them all.

"No... it's not my job."

"Sorry, I don't know."

Or just ignored me. I felt like the biggest idiot asking question after question but considering there was no real formal training program, I guess I got by after four weeks of it.

Andy gave me a brand-new shiny white notebook filled with a 5 week training schedule, a page to write down all my usernames and passwords... (um... doesn't that defeat the purpose?), and blank pages to write notes. OK.

A few words about the training schedule.

I don't know how many of you pharmacists out there have specialty pharmacists, but it's this new phenomenon of further separating the pharmacists from those with residencies and fellowships. We have a few female specialty pharmacists: critical care, infectious disease, pain management, and a couple of others. And their boss, Ann, who has about a month left before she moves away. Most of the regular staff (non-residency pharmacists) cannot stand Ann because they say she forced more work on them and our boss Andy didn't stand up for them. OK. Whatever. Now we have to calculate creatinine clearances for Vancomycin, etc... Big deal. Doesn't matter to me.

Part of the training schedule included meeting with every single one of the specialty pharmacists, etc... and discussing what they do and taking me up on the floors to see them in action. One of them did her job with that setting up the meeting and showing me what she does, etc... One of them mentioned setting something up in three or four days but never delivered or remembered it later (That would be Jessica, who seems nice enough)... is that MY job to remind her? It's THEIR TRAINING PROGRAM! Another one of them, Kimmie, never mentioned it or anything. Geeze. So I didn't see any of it.

The third week, I saw my boss Andy completely ass out. We have automatic orders that can be ordered in group by physicians and we don't have to see the actual written orders... they are pre-approved orders. They print off all day as the orders are being entered along with the scanned and written images we see. Sometimes we get a little bit behind on the pre-approved orders. Andy waltzes into our little room and asses out one day as we are behind on them but also severly understaffed. I saw the real Andy. He's passive aggressive.

Also the third week was when it was discovered by me that although we are in one department, we are severly divided. Staff vs. Clinical. I'm staff. Ann, Kimmie, Jessica, and management with some others are clinical. They have private celebrations for one another without including the staff and don't have the decency enough to take it off site but rather leaves us out. Like I care... but I remember the terms used in my interview...

"Oh Blonde Pharmacist...." Andy says nicely, "We have the best team attitude and everyone is positive and we are making sure that all new hires fit with us and vice versa."

Um. OK. I see what's going on here. He's hiring one person at a time to try to change the culture.

I don't want to be a part of the revolution!