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Patients haunted by pharmacist's dosage deception
©Los Angeles Times
© St. Petersburg Times, KANSAS CITY, Mo. -- The patients will never know for sure. And it is an agony. Their pharmacist, Robert Courtney, has admitted he diluted chemotherapy drugs. He gave patient after patient a third, a fifth of what they needed to fight cancer. He made more money that way. And the patients who sat there, hour after hour as the chemo dripped into their veins? They do not know how much medication they actually got. And how much was saltwater. They will never know how much the deception might have cost them. How many months? How many years? "It is a haunting feeling," Delia Chelston says. "Unthinkable." She is 68. She has advanced ovarian cancer. She trusted Courtney's drugs to beat it. Now she is afraid. Did he rob her of a ballgame with her grandson? Of a chance to plant her tomatoes in the spring? Anger gnaws at the strength she knows she must conserve. Courtney is behind bars, facing charges that could bring him 196 years in prison. Federal investigators say he told them he diluted four chemotherapy drugs repeatedly, "out of greed." Charge for a full dose, deliver less than half, pocket hundreds of dollars. It was an easy scam. He tried it out a few times last November, he told investigators. Then in the spring, he started again. The FBI caught him in a sting operation last month. Tipped off by a suspicious oncologist, they tested 10 chemotherapy prescriptions Courtney had prepared. Not one was at full strength. The strongest contained 61 percent of the dose ordered. All the rest had less than 40 percent. The weakest, the government alleges, was virtually all saline solution. When they came to his pharmacy on the south side of Kansas City, FBI agents asked Courtney whether he could explain. "No sir, I can't," he replied. "I don't understand it." Two days later, Courtney agreed to another interview with the FBI, this time with his lawyer at his side. He admitted diluting the chemotherapy drugs Gemzar, Taxol, Platinol and Paraplatin, which are dissolved in saline solution and given intravenously. He even laid bare his motive. He did it "in order to make more money," documents filed in federal court show. Courtney's attorney has not contested these allegations. He has not disputed the FBI's account of Courtney's confession. He has openly discussed the number of patients who could have received the weakened drugs. Still, preserving his legal options, Courtney has pleaded not guilty to 20 criminal counts. His trial is set for October. Eighty FBI agents are working on the investigation. They're poring over records, interviewing patients, answering the nearly 2,000 calls that have flooded a hotline. It's as much counseling as it is investigation: They spend hours each day talking to sobbing cancer patients and their loved ones, trying to ease them through the anguish. Oncologists who used Courtney's pharmacy are doing the same with their patients. Or with the relatives of those dead. "That may be the awful legacy of this thing. We may never be able to say to the patients: "You were or were not affected,' " says Patrick McInerney, an attorney representing several physicians who unknowingly may have dispensed the diluted drugs. Courtney has insisted he tampered only with prescriptions for one physician. He estimates 30 to 35 patients were affected. The FBI, however, says at least 10 oncologists may have used the diluted drugs. The number of victims could be "in the hundreds," FBI spokesman Jeff Lanza says. "We're not counting on (Courtney's) statements as the final word." Indeed, agents are reviewing pharmacy records going back to 1995. They also are exploring the possibility that Courtney tampered with other medications. Records released this week show that investigators also think Courtney tampered with prescriptions for Procrit, a medication used to counter the side effects of chemotherapy; Tissue Plasminogen Activator, a medication that fights blood clots during surgery; and possibly Anzemet and Zofran, which are used to combat the nausea and vomiting often associated with chemotherapy. Even if investigators come up with a list of patients who received watered-down drugs, they could not begin to approximate the toll. Many of the patients who received Courtney's chemo had late-stage, terminal cancer. Even a full dose may not have made a difference. But who can say for sure? "My family will always wonder what could have been," says Kim Comfort, whose mother, Adelia Atwood, died of ovarian cancer in February after $84,000 of chemo from Courtney's pharmacy. Comfort is convinced her mother received weakened drugs. "She was cheated," Comfort says. Cheated, perhaps, of a fighting chance. And cheated, perhaps, of time. Time to finish the dress she was sewing for her granddaughter. Time to make more of the recipes she had stashed in her kitchen. Time to celebrate her 45th wedding anniversary. She died five months shy of it. Her husband, Ken, tries not to think they could have had more. Adelia wouldn't want him to be bitter, he says. So he is philosophical: "What could have been, could have been. But it wasn't." His daughter, however, is fierce. "This will haunt my family," she says, "for the rest of our lives." Courtney told investigators he did it "out of greed," court papers state. Prosecutors hint at a more specific motive: a $600,000 tax bill coming due. But it does not appear Courtney faced insurmountable debt. Other than the tax bill -- which has been paid, his lawyer says -- Courtney owed nothing except his monthly mortgage. Court records show that he holds $8.5-million in stocks and bonds. He owns two pharmacies in the Kansas City area, with a combined value of $1.1-million. He is well off enough to donate $25,000 a year to charity. Courtney's assets have been frozen pending his trial. The two pharmacies are being sold. The judge hearing the case has refused to release him on bail. "Defendant's willingness to risk the lives of several people . . . in order to add to his fortune of over $10-million clearly establishes the danger he presents to the community," Judge Robert Larsen wrote in his detention order. Calling Courtney's alleged crimes "startling and violent," Larsen said: "If he is willing to commit and then admit to such conduct, I cannot imagine what else he may be capable of." Those close to Courtney, however, paint a different portrait of the 48-year-old pharmacist. He is a compassionate man, they say. Devoted to his family and his church. "An ideal son," his father, a retired minister, testified in court, between sobs. "A month ago, I wouldn't have even thought him capable of this," said pharmacist Dennis Hendershot, who has known Courtney for 25 years. In addition to the criminal charges, Courtney faces an onslaught of lawsuits. At least two dozen already have been filed by cancer patients and their families. Several of the lawsuits also target Eli Lilly & Co., the pharmaceutical company that manufactures Gemzar. In court documents, federal investigators reported that Lilly salesman Darryl Ashley "began having concerns about the Research Medical Tower Pharmacy as early as the first part of 2000." Lawyers for the plaintiffs contend Lilly should have acted. But company spokesman Jeff Newton says the issues Ashley raised at the time dealt purely with Courtney's bookkeeping: He wanted to make sure sales figures were accurate so he could get credit toward a bonus. Lilly investigated and found that sales figures for the Kansas City area as a whole were inaccurate due to sloppy reporting by wholesalers. The "weird and unreliable" numbers showing up in Courtney's records were dismissed as part of the overall accounting problems in the region. By January 2001, Lilly had straightened out the region's bookkeeping woes. But when Ashley checked Courtney's records in April to determine his first-quarter bonus, he found the numbers still didn't add up: The pharmacist was buying far less than he would have needed to fill all the prescriptions. In May, Ashley reported the discrepancy to an oncologist who used Courtney's pharmacy regularly. She had a bag of chemotherapy tested -- and found it was only one-third the strength it should have been. The FBI and the Food and Drug Administration then took over, launching the sting.
 © 2006 • All Rights Reserved • St. Petersburg Times
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