Kansas City, Mo. ? Doctors in Missouri and Kansas may learn this week whether their patients received diluted drugs from pharmacist Robert Courtney.

Meanwhile, federal investigators are looking into whether the dilutions may have dated back as far as 1985, when Courtney first became a pharmacist, FBI spokesman Jeff Lanza said Monday.

Federal authorities announced Friday that Courtney had diluted 72 drugs, dating back to at least 1992 and affecting about 400 doctors and 4,200 patients. He originally admitted to diluting two chemotherapy drugs beginning in November of 2000 and intensifying in March through May of 2001.

Lanza said Courtney now says he diluted the drugs “on virtually every occasion.”

“Now, if Courtney is telling the truth … then doctors getting the letters if they received drugs during that time frame they were diluted,” Lanza said.

The drugs in question were used mainly to treat cancer, but also included antibiotics, iron supplements, blood thinners and drugs to combat the nausea that often accompanies chemotherapy.

Older records hard to find

Federal investigators said it would be difficult to determine which, if any, drugs were diluted before 1992. Investigators were not sure whether the older records would be retrievable, Lanza said. Pharmaceutical records compiled since 1992 are more accessible because they are kept on computers.

“We aren’t sure when this case is going to end, if ever,” Lanza said.

A hot line set up to answer calls from people who think they may have received diluted drugs had received 300 calls between Friday and midday Monday, Lanza said.

Chain of notification

Public health officials in both states now must notify doctors who in turn are to notify their patients.

Federal officials contacted three public health agencies in each state earlier this month and asked for their assistance in contacting the additional doctors.

State health officials received the lists of drugs, doctors and patients on Wednesday two days before the U.S. Attorney’s Office publicly announced the expanded scope of Courtney’s drug dilutions.

Kansas officials mailed letters Friday to between 100 and 200 doctors mainly in the Kansas City area notifying them that their patients may have received diluted drugs, said Mary Tritsch, spokeswoman for Kansas Atty. Gen. Carla Stovall.

Stovall’s office worked with the Kansas Board of Healing Arts, the Kansas Department of Health and Environment and the Kansas Board of Pharmacy to send out the notifications.

Missouri health officials, meanwhile, on Monday were checking the addresses of about 300 doctors whose patients may have been affected. A meeting was planned for today to decide when to mail the letters and how to help doctors, said Tina Steinman, executive director of the Missouri State Board of Registration for the Healing Arts.

‘The best we can do’

Mark Stafford, general counsel at the Kansas Board of Healing Arts, said the task was challenging, with no addresses to distinguish “one John Smith from another John Smith.” Also, some of the doctors had moved a handful to different states.

“The best we can do is to take the list of doctors given to us and have staff physically check our lists of people we’ve licensed and match up names as best we can,” Stafford said.

With the information in the hands of doctors, Stafford said, the case has now moved from the criminal prosecution realm to the public health arena.

Steinman said her office also had struggled with the notification process in Missouri. Some of the physicians listed don’t have current licenses in the state and workers have spent time tracking them down through the American Medical Assn. and American Osteopathic Assn.

“I’ve been in this business 20 years and it’s hard to be shocked or surprised anymore,” she said. “I think it’s horrible what happened, but my first reaction is I have a job to do and need to get it done as soon as possible.”