The last section of this article will address the pharmacist's role in dealing with the growing prevalence of fraudulent prescriptions. To aid in the discussion, two recent cases will be examined.
The article will conclude with some recommendations from the U.S. Department of Justice as to ways a pharmacist can identify and prevent prescription fraud.
United States v. Russell
1998 U.S. App. LEXIS 5775 (6th Cir. Mar.19,1998)
In this case, defendant James Russell, formerly a licensed pharmacist, appealed his conviction for conspiracy to distribute controlled prescription drugs. The evidence presented at trial revealed the following pattern of events.
Clarence Wilson, D.O., a co-conspirator with Russell, had a clientele consisting of a large number of patients who complained of many of the same bogus symptoms and who appeared to be drug addicts. Wilson would perform perfunctory examinations of these patients and then liberally issue prescriptions. The prescriptions, which were substantially similar, whoever the patient, typically consisted of a dangerous combination of controlled and uncontrolled drugs. Wilson would rewrite the same 30-day prescriptions for the patients when they returned month after month, without further examination or diagnosis. According to expert testimony, Wilson prescribed controlled drugs without apparent medical need and outside the course of usual medical practice. Despite this fact, pharmacist Russell serviced the majority of Wilson's patients, even while other pharmacists refused. Filling prescriptions for Wilson's patients constituted between 80% to 93% of Russell's total business. In fact, Russell told a DEA agent that he depended upon Wilson's patients.
Expert testimony revealed the apparent reasons why many area pharmacists refused to fill these prescriptions: (1) the prescribed drugs were dangerous when taken in combination; (2) it was odd to prescribe this same protocol for the same patients over such a prolonged period of time; (3) Wilson's patients were often troublesome and unruly; and (4) many of Wilson's patients appeared to be under the influence of drugs. Russell apparently devised a system to allow Wilson's patients to receive only the drugs they desired, typically the controlled substances, from the combination prescriptions that included additional medications. This procedure was purportedly instituted to address Wilson's patients' general inability to pay for the prescribed drugs in their entirety. Not persuaded by this sham procedure, the court of appeals affirmed Russell's conviction. In its opinion, the court of appeals relied on the district court's finding that this practice provided circumstantial evidence that Russell knew the prescriptions were not valid but that he cultivated the illicit business by allowing the patients to opt for the controlled substances without having to pay for the unwanted noncontrolled drugs.
This case was mentioned to compare and contrast pharmacists and their respective standards of practice. The defendant pharmacist, James Russell, filled every prescription that came into the pharmacy. Russell had intimate knowledge of Dr. Wilson's practice and repeatedly witnessed the same prescriptions for the same patients. Although this should have sounded an alarm to Russell, he chose to look at the financial rewards over the needs of his patients. As a result, Russell lost his license to practice. In essence, Russell was not practicing pharmacy but merely filling prescriptions. However, a difference existed in the pharmacists who testified at Russell's trial. They all testified that they refused to honor Wilson's prescriptions because they included excessive and/or contraindicated controlled substances. These pharmacists are excellent representatives of the profession because they truly practice pharmacy. Their actions reflected a pharmacist's responsibility as a health-care professional. For more information on pharmacist responsibility in dealing with prescription fraud, see Fig. 3.