Can anyone please give me more insights about the Biloxi pharmacist's case?

Nov 14, 2010
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http://www.wlox.com/Global/story.asp?S=13285165

I can see this Biloxi guy killed someone with too many Lortabs, and probably are way too close with the doctors next door. Now the issue I am wondering is they are referring to the rx's as being "illegitimate". I am working as a tech-intern now for a small independent, and have to to call up the doctors upon receiving those CS rx's. If the doctors already had bad intents, they will confirm them (in fact I never have a doctor's office not confirming a CS script).
I am reading this as, if the doctors are crooks, then you become an accomplish. Can some one please shed some light on this matter, because I am about to chase all the oxy patients out with a broom as of this moment. Hope for your insights!
 

owlegrad

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http://www.wlox.com/Global/story.asp?S=13285165

I can see this Biloxi guy killed someone with too many Lortabs, and probably are way too close with the doctors next door. Now the issue I am wondering is they are referring to the rx's as being "illegitimate". I am working as a tech-intern now for a small independent, and have to to call up the doctors upon receiving those CS rx's. If the doctors already had bad intents, they will confirm them (in fact I never have a doctor's office not confirming a CS script).
I am reading this as, if the doctors are crooks, then you become an accomplish. Can some one please shed some light on this matter, because I am about to chase all the oxy patients out with a broom as of this moment. Hope for your insights!
The word is accomplice. :laugh:

Interesting article. Sounds like he didn't care how many painkillers he sold to the same patients as long as the prescriptions weren't "fake". I am split on this one. On the one hand I don't care for punishing the pharmacist for what the doctor's wrote, but on the other hand it is not appropriate to keep dispensing C2 and 3's early to the same patients month after month. He was not practising responsibly.

10 years in prison strikes me as punitive. Like the article mentions in the end they wanted to set an example. Sad.
 

Praziquantel86

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"Mr. Tran has been held to the level of a physician. And it requires him to determine whether or not a prescription has been issued properly for the right disease or treatment and for the right diagnosis. And he's not qualified to do that. Simply put, pharmacists are paid to do what the doctor orders them to do," said the defense attorney.
Well that sucks.

I don't think the prosecutor would have a hard time finding any number of expert witnesses to argue that.

This guy seems like a scumbag, and he probably got what he deserved. Good riddance.
 

All4MyDaughter

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Let's be clear. The article DOES not say he "killed someone" with Lortabs. The article has a quote from a woman who has a loved one who died of "drug related causes." It doesn't elaborate. The pharmacist wasn't convicted of murder. He was convicted of participating in a "drug conspiracy" which suggests that he knew the RXs coming from the clinic next door were not being used for legit medical purposes but he looked the other way. Seems irresponsible and greedy to me.
 

lauradiddle

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Forgive me if I'm wrong, but I thought a PharmD makes Tran absolutely qualified to be "held to the level of a physician" and be required to "determine whether or not a prescription has been issued properly for the right disease or treatment and for the right diagnosis". A pharmacist's job is not to blindly dispense every order that comes through without second thought. When a woman comes in with another prescription of a narcotic only two weeks after he dispensed her a 30-day supply, he shouldn't have ignored the red flag that was waving right in front of his face. Hell, I can't even get my next month's supply of birth control from my pharmacy more than a few days before my current month runs out. This is just unacceptable. Ten years in prison might be a little harsh, but he's a terrible pharmacist and should never practice again.
 

WhiteSnows

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Let's be clear. The article DOES not say he "killed someone" with Lortabs. The article has a quote from a woman who has a loved one who died of "drug related causes." It doesn't elaborate. The pharmacist wasn't convicted of murder. He was convicted of participating in a "drug conspiracy" which suggests that he knew the RXs coming from the clinic next door were not being used for legit medical purposes but he looked the other way. Seems irresponsible and greedy to me.
How can a person know what happened next door? And how can you prove such a case?
 

All4MyDaughter

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How can a person know what happened next door? And how can you prove such a case?
Well it could be something like a patient who testified, "The doctor told me to take my script next door because they had an arrangement with the pharmacist and he'd fill it without asking questions."

Or perhaps they had proof of a kickback system between the doctor and pharmacist.

Or maybe one of the doctors sold out the other doc and pharmacist and testified in exchange for a shorter sentence.

The possibilities are endless. There are a lot of ways to prove conspiracy. They must have had some evidence to convince a jury "beyond a reasonable doubt."
 

Doctor M

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Well it could be something like a patient who testified, "The doctor told me to take my script next door because they had an arrangement with the pharmacist and he'd fill it without asking questions."

Or perhaps they had proof of a kickback system between the doctor and pharmacist.

Or maybe one of the doctors sold out the other doc and pharmacist and testified in exchange for a shorter sentence.

The possibilities are endless. There are a lot of ways to prove conspiracy. They must have had some evidence to convince a jury "beyond a reasonable doubt."
Something does not add up...We get prescriptions from time to time from different clinics where the patient has an early refill, say like 8 days and we call the clinic to confirm the early refill and the reason why and we document this on the rx. You must document and be sure that the patient is
1)going away
2)Lost the rx
3) the patient was taking more than prescribed and the doctor did indeed increase the dosage.

But to refill lortab 14 days early with no questions asked, everyday, with no documentation is irresponsible and opens you up to legal action sooner or later. Whether we like it or not, the government is on a crusade, and it's just best to ask questions and document. Our job is to not Police, but to make sure the prescription is being used for a legitimate medical reason. Also, the pharmacist is under no obligation to fill the clinics prescriptions...Unless there was money involved of some sort...To many questions unanswered to judge.
 

WhiteSnows

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Something does not add up...We get prescriptions from time to time from different clinics where the patient has an early refill, say like 8 days and we call the clinic to confirm the early refill and the reason why and we document this on the rx. You must document and be sure that the patient is
1)going away
2)Lost the rx
3) the patient was taking more than prescribed and the doctor did indeed increase the dosage.

But to refill lortab 14 days early with no questions asked, everyday, with no documentation is irresponsible and opens you up to legal action sooner or later. Whether we like it or not, the government is on a crusade, and it's just best to ask questions and document. Our job is to not Police, but to make sure the prescription is being used for a legitimate medical reason. Also, the pharmacist is under no obligation to fill the clinics prescriptions...Unless there was money involved of some sort...To many questions unanswered to judge.
This helps, thank you.
 

All4MyDaughter

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The article was light on details and is certainly not the entire story. The only way to know more definitively would be to obtain the court transcripts and see what testimony was offered and what was entered into evidence. I did notice that the two doctors PLEAD GUILTY and may have done so in exchange for leniency. Perhaps they testified against the pharmacist.
 
OP
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I agree with what all of you say. However, I think it is also our job to dispense narcotics if the patients do have a legitimate need for it.

It is one thing if the person comes crawling in with an axe stuck into his forehead, but other cases I am not so sure. That is why I have to call up to the doctors to make sure there is a valid diagnosis. I don't think most pharmacists can just look at a person and tell what kind of pain they are in. After all, you can be in trouble for denying legitimate medical needs. Now in this case, it seems to me the DEA still will crack your nuts for the following two scenarios:

1) That the doctors are found to be pill mill scums.
2) Or if the phone number on the rx that you called was fake, just like the Rxs itself.

I just got a tech job only recently, so I am very inexperienced with these kinds of things (and cannot spell, if you noticed). It is less of a concern for me now, but soon it will be my butt in about four more years so it is best for me to ask this early. Thank you so much!
 

Doctor M

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I agree with what all of you say. However, I think it is also our job to dispense narcotics if the patients do have a legitimate need for it.

It is one thing if the person comes crawling in with an axe stuck into his forehead, but other cases I am not so sure. That is why I have to call up to the doctors to make sure there is a valid diagnosis. I don't think most pharmacists can just look at a person and tell what kind of pain they are in. After all, you can be in trouble for denying legitimate medical needs. Now in this case, it seems to me the DEA still will crack your nuts for the following two scenarios:

1) That the doctors are found to be pill mill scums.
2) Or if the phone number on the rx that you called was fake, just like the Rxs itself.

I just got a tech job only recently, so I am very inexperienced with these kinds of things (and cannot spell, if you noticed). It is less of a concern for me now, but soon it will be my butt in about four more years so it is best for me to ask this early. Thank you so much!
In some cases, a diagnosis is useless if you dont know what it is...
 

owlegrad

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I agree with what all of you say. However, I think it is also our job to dispense narcotics if the patients do have a legitimate need for it.

It is one thing if the person comes crawling in with an axe stuck into his forehead, but other cases I am not so sure. That is why I have to call up to the doctors to make sure there is a valid diagnosis. I don't think most pharmacists can just look at a person and tell what kind of pain they are in. After all, you can be in trouble for denying legitimate medical needs. Now in this case, it seems to me the DEA still will crack your nuts for the following two scenarios:

1) That the doctors are found to be pill mill scums.
2) Or if the phone number on the rx that you called was fake, just like the Rxs itself.

I just got a tech job only recently, so I am very inexperienced with these kinds of things (and cannot spell, if you noticed). It is less of a concern for me now, but soon it will be my butt in about four more years so it is best for me to ask this early. Thank you so much!
I just don't understand the point. Does the doctor ever give an invalid diagnosis?
 

297point1

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"Mr. Tran has been held to the level of a physician. And it requires him to determine whether or not a prescription has been issued properly for the right disease or treatment and for the right diagnosis. And he's not qualified to do that. Simply put, pharmacists are paid to do what the doctor orders them to do," said the defense attorney.

Thank you for reinforcing the public's perception of a pharmacist, Mr. Defense Attorney. For using that line of defense, your client deserves ten years in the hoosegow.

As a profession, we cannot push for all of these additional patient care responsibilities, only to hide behind the historical role of a pharmacist whenever it is convenient for us.
 

MountainPharmD

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"He's so arrogant, just that he wasn't guilty. I've worked in a pharmacy setting. I know the protocols. And he didn't follow them. Regardless of what his attorney said. We're not asking him to question every prescription that comes through, but when somebody comes through every two to three weeks wanting 100 Lortabs; don't fill 'em," said Creel.

Interesting story. I think there is alot more to this than what was printed in the article. I do not think anyone is going to get 10 years in federal prison for dispensing one Lortab prescription 14 days early. However you may get 10 years if you dispensed thousands of prescriptions for controlled substances early. The Lortab example above is a bad one and typical of the ignorant people out there. 100 Lortab 5/500 at the max dose per day of 8 is a 12.5 day supply. Someone could very well come in every 2 weeks and get a 100 Lortab and have it be perfectly legitimate. In this case we are probably talking about hundreds if not thousands of patients and a repeated pattern of irregularities over a long period of time.

This is directly from the Pharmacists manual on the DEA's website:

To be valid, a prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. The practitioner is responsible for the proper prescribing and dispensing of controlled substances.
Corresponding Responsibility. A pharmacist also needs to know there is a corresponding responsibility for the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is an invalid prescription within the meaning and intent of the CSA (21 U.S.C. § 829). The person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances.
The Doctors in this case plead guilty. According to the law the Pharmacist has a corresponding responsibility and is guilty as well. So sorry Mr. Tran you cannot hide behind the excuse "Hey I just count the pills and fill the prescriptions."
 
OP
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I just don't understand the point. Does the doctor ever give an invalid diagnosis?
Nope, all sounds too valid and too severe for a person to be seen standing up straight at the pharmacy, and that is the problem.
 

owlegrad

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Nope, all sounds too valid and too severe for a person to be seen standing up straight at the pharmacy, and that is the problem.
So should we tell the patient they don't seem to be in enough pain to warrant their medication? I am serious. Do you want them to moan and groan while picking up their medication?

Multiple early fills are one thing (do not play that game), but trying to decide who needs pain management therapy and who does not is not something I am interested in doing.

Are mail-order facilities allowed to dispense CII's? And if so how do they handle this problem?
 

Doctor M

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So should we tell the patient they don't seem to be in enough pain to warrant their medication? I am serious. Do you want them to moan and groan while picking up their medication?

Multiple early fills are one thing (do not play that game), but trying to decide who needs pain management therapy and who does not is not something I am interested in doing.

Are mail-order facilities allowed to dispense CII's? And if so how do they handle this problem?
I dont think anybody is...Im certainly not, but again, the DEA controls how much you order and this causes a problem...Who do I fill for?? It's a never ending BS game.
 

spacecowgirl

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So should we tell the patient they don't seem to be in enough pain to warrant their medication? I am serious. Do you want them to moan and groan while picking up their medication?

Multiple early fills are one thing (do not play that game), but trying to decide who needs pain management therapy and who does not is not something I am interested in doing.
I completely agree. Should a person have to crawl to the pick-up counter to demonstrate appropriate pain? Maybe they are able to stand upright because they are properly treated for their pain? There was obviously a problem with the pharmacist and doctors involved in this case, but I worry about creating unnecessary fear of opioids by all healthcare providers. It is injurious to patient care to be suspicious of everyone who is prescribed a controlled substance. Drug seeking behaviors can also be caused by inadequate pain control, not just by addiction.

Believe me, I have dealt with and continue to deal with my fair share of drug seekers who waste time and resources. I'm not defending that behavior at all. I do worry that those people color our impression of everyone, including legitimate pain patients. It takes a conscious effort to look at each patient without judgment and I have to remind myself of that when I have someone that is getting antsy about getting a narcotic filled. If I had chronic pain, I too would be concerned about running out of medication. If only our diabetic patients were so concerned about their med adherence.

I trust my patients until they demonstrate otherwise. You try to scam me and it’s game over. I should be more worried about the lady who wanted Alli through the drive-through or a diabetic buying Ho-Hos and insulin.

/soapbox