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Executive Summary

MEDCO CRIMINAL NEGLIGENCE CASE DISMISSED OCT. 7, with the understanding that the company incorporate safeguards into their operations, Latah County (Idaho) Prosecutor Craig Mosman told a "town hall" meeting at NARD's Oct. 0-13 annual convention in Atlanta. In a joint Oct. 7 press release, Latah County and Medco Containment Services said: "As a direct result of the criminal preceeding, the company has repositioned the location of the drug Coumadin [warfarin] in its dispensing system. Coumadin is alleged to have been erroneously dispensed." Latah County charged that the Medco plant juxtaposed automated dispensing units containing Coumadin and prednisone where they could be easily confused by hurried employee pharmacists. Noting that he was under a court-imposed gag order that prevented him from disclosing terms of the settlement, Mosman told NARD only that the conditions agreed to by Medco accomplished one of the "goals" of prosecution -- enhancing consumer safety -- by forcing the company to improve its procedures. "I can't talk about all the conditions they were placed under, but [the case] was dismissed with a number of different conditions." The complaint was brought against Medco by Latah County when an Idaho woman died from a brain hemorrhage after taking warfarin allegedly dispensed as a prednisone prescription by Medco's Las Vegas subsidiary, National Rx Services. Mosman indicated that the county's decision to settle was based, in part, on budget concerns. "My budget for prosecuting criminal cases is $ 3,000 per year. That includes all the complicated elk-killing cases," he said. Consequently, "a local hick county prosecutor [was] in the position of taking on a company with" millions of dollars of assets. Successful criminal prosecution, on the other hand, would have resulted only in a $ 10,000 fine, which "was clearly inadequate to be able to meet any of the goals of the criminal justice system," Mosman said. The joint press release quotes Mosman as saying: "Given the status of Idaho Law, the facts of this case, and the substantial cost to be incurred by county residents, further criminal prosecution is unwarranted." Besides forcing changes in Medco's business practices, the prosecutor said the complaint was successful in raising public awareness of the potential hazards of mail-order pharmacy through the publicity generated by the case. "There's a documented case of a woman in Boise, Idaho who received a misfilled prescription from this same #Las Vegas' plant; that prescription is now in the possession of the Idaho state board of pharmacy," he maintained. However, the woman checked her vial "and wondered about it . . . because of publicity of the criminal case." The joint release stated that "a thorough evaluation of National's procedures and policies by the relevant regulatory and investigatory agencies demonstrated that National employs a system that contains numerous quality controls and enjoys an above-average safety record." In a separate Oct. 13 statement, Medco Senior Executive Vice President James Manning said the company was "pleased with the dismissal of the charge." However, Manning said it was unfortunate that "much of the attention paid to this case has been prompted by the special interests of the retail pharmacy industry, which is motivated more by economic self-interest than a willingness to compete on standards of safety, quality, and cost-effectiveness."

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