Kansas City, Mo. — In a grim repeat of a scene from last August, doctors at Kansas City Internal Medicine began sifting through medical records and documents from Robert Courtney's pharmacy to identify patients who may have gotten watered-down drugs.
The FBI now believes Courtney may have diluted drug mixtures for 4,200 patients, since at least 1992. Until last week, Kansas City Internal Medicine thought perhaps 700 of its patients were affected. Now, clinic lawyer Patrick McInerney says there could be 2,500 victims among the clinic's patients.
"I don't think we had any idea" of the number of possible victims, McInerney said. "You assume the worst, but now you know the worst."
Courtney, 49, pleaded guilty in February to 20 counts of tampering and adulterating or misbranding the chemotherapy drugs Taxol and Gemzar. At the time, authorities said they had confirmed that the dilutions involved 34 patients, although investigators always said more were possible.
Courtney's plea agreement called for him to tell prosecutors everything he knows about the dilutions. Based on Courtney's latest statements, the FBI now believes he watered down 72 drugs, including antibiotics, AIDS medicine, and anti-nausea medications. All the drugs were administered intravenously or through injections.
Kansas City Internal Medicine got the news on Thursday, and the FBI released it to the public on Friday. Still, the Missouri Department of Health and Senior Services does not plan to meet until Monday at the earliest to begin planning how to notify individual doctors who may have prescribed drugs from Courtney, spokeswoman Nanci Gonder said.
"I don't know that it was discussed as something that needed to be done immediately," she said.
Kansas health department spokesman Mike Heideman said he had no word on when Kansas agencies would begin notifying doctors.
McInerney said workers at Kansas City Internal Medicine have experience at matching their own records to Courtney's, as they did when Courtney was charged in August. But the scale is much larger now.
"We kind of had to invent the wheel in August," he said. "Now, the wheel's a lot bigger."
McInerney praised the FBI for providing Courtney's records electronically, making it easier to begin matching them to patient records.
Still, he said, Courtney "was not the world's greatest record keeper."
The job is tougher for clinic workers because of the long time span involved. Courtney now says he began diluting many drugs in 1992, possibly earlier.
At the clinic, older records are stored at another location, and some doctors who worked there in the early 1990s have left, McInerney said. That means clinic workers often have to work like detectives to track down the information they need before patients can be notified.
All of this takes a toll on doctors and nurses at the clinic.
"This is not ordinary work," McInerney said. "This is work with weight, as they say.
"It's bad news made worse."
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