IMPAIRED DRUGGISTS POSE SERIOUS THREAT

Pharmacist Connie Bennett fell asleep one day while compounding a liquid
prescription.

Another time, she couldn't tell a nurse at a hospital in Poplar Bluff, Mo.,
the correct drip rate for an intravenous solution. She offered a guess,
then withdrew it.

When Bennett mixed too little of another prescription, a patient's
intravenous pump ran dry and blood backed up into the line. That resulted
in "direct harm, or in the very least, discomfort to the patient,"
according to Missouri pharmacy board records.

Bennett's problem? Drug misuse.

Each year, hundreds of U.S. pharmacists pose a direct threat to the public
because they are abusing drugs or alcohol. Missouri disciplined 10 impaired
pharmacists last year alone. Virginia disciplined 15, Michigan 20 and Texas 29.

People are much more likely to receive prescriptions from an impaired
pharmacist than from a Robert R. Courtney, the Kansas Citian who diluted
cancer drugs for profit.

Studies from the 1980s estimated that 10 to 20 percent of pharmacists would
have a substance-abuse problem some time in their lives. A study published
last year in the Journal of the American Pharmaceutical Association found
that 20 percent of surveyed pharmacists had taken potentially addictive
drugs at least five times without a prescription.

The rate of impaired pharmacists could be double that of the general
public, some studies have concluded.

It's a problem that health-care professionals face in part because they
have access to drugs and some think they can safely control drug usage.

"In pharmacy school, you learn all about drugs. You learn all about their
actions and how they affect people," explained Brian Fingerson, director of
the Kentucky Pharmacist Recovery Network. "That knowledge tends to say to
you, `Nothing is going to happen to me, because I know all about this stuff."'

What starts as one pill leads to two pills. Eventually some pharmacists
forge prescriptions or steal drugs from work.

"Generally, it starts with off-the-job use," said Fingerson, who has dealt
with more than 110 impaired pharmacists in Kentucky since 1986. "There have
been cases where we've had to remove someone from a practice setting
because they were under the influence while they were practicing."

`More problematic'

A survey by a Georgia State University professor found that nearly 40
percent of responding pharmacists said they had used a potentially
addictive prescription drug without getting a doctor's prescription. More
than half of those persons admitted repeated use.

"I find this subject matter to be one that gets very little attention but
is potentially more problematic than general street use (of drugs)," said
study author Dean Dabney, an assistant professor of criminal justice at
Georgia State. "A pharmacist who makes a mistake...can kill someone."

Twenty-nine states that responded to a Kansas City Star questionnaire
reported disciplining a total of more than 260 impaired pharmacists last year.

The problem is big enough that nearly every state, including Kansas, has a
treatment and recovery program just for impaired pharmacists.

Missouri is one of only four or five states without such a program.

Kansas created its Committee of Impaired Pharmacy Practice in 1987, about
the same time it offered a program for impaired physicians. The issue arose
because doctors were facing large numbers of malpractice lawsuits.

In Kansas, participation is confidential -- meaning the Board of Pharmacy
doesn't know names -- unless someone fails to follow program rules.
Pharmacists must enter treatment and agree to monitoring through random
drug screens for five years.

In some cases, states suspend pharmacists' license until they are deemed
safe to return to work. Other states allow pharmacists to remain on the
job. Some state boards are told who's in the program. Other boards do not
know, unless they've ordered pharmacists to participate.

Missouri cases

Although Missouri has no state program, impaired pharmacists who appear
before the pharmacy board usually are ordered into private treatment.

Records show that the Missouri board tends to put impaired pharmacists on
probation for three to five years, although some had their licenses
suspended or revoked. Under probation, pharmacists can continue to
practice, but under closer scrutiny.

Among the cases:

. A Kansas City pharmacist who worked at two Independence pharmacies and
became addicted to the nasal spray Stadol. She started forging
prescriptions. In 1997, she was put on probation and ordered into
treatment. In late 1999, she voluntarily surrendered her license, an action
typically taken to keep a license from being revoked. Earlier this year,
she regained her license with conditions, including that she remain in a
treatment program and submit to periodic urinalysis or blood tests.

. A pharmacist in three Missouri grocery stores who allegedly abused at
least four controlled substances, including the painkiller Vicodin, in 1996
and 1997. In 1998, the Lee's Summit man was put on probation for five
years. He remains licensed today.

. A Springfield pharmacist who lost his license after he was caught
manufacturing methamphetamine in 1998 when firefighters responded to an
explosion in his recreational vehicle. He contended that he was making meth
only for personal use, records show. Citing "a clear and present danger to
the public health and safety," the pharmacy board revoked his license. At a
disciplinary hearing in 2000, the pharmacist said he remained licensed in
Texas and asked for reinstatement in Missouri. The board denied the request.

In the Bennett case, co-workers, nurses and others in Poplar Bluff gave an
inspector chilling accounts of how Bennett's work suffered:

She fell asleep often and seemed unaware of her surroundings. She misfilled
prescriptions. She gave a customer the wrong drug twice in one day.
Controlled substances disappeared from pharmacies where she worked, records
showed.

When an intravenous pump ran dry prematurely for a patient, home health
nurse Machele Mossman checked the machine before suspecting something was
wrong with the prescription. Mossman said she and a supervisor searched the
pharmacy's trash for the medicine bottles used to fill the prescription.
Three of the four bottles still had liquid in them, meaning the IV bag
contained too little medication.

Mossman said she felt uncomfortable questioning a pharmacist's abilities.

"We think they are like physicians and they know what they are doing," said
Mossman, of Williamsville, Mo. "But how do I know the pharmacist took the
right medication and injected it into the IV bag the right way? I don't
know that. I think they are human, and they need to be checked on like
anybody else."

Bennett no longer has a Missouri pharmacy license. She now lives in
Arkansas, where she is licensed to practice.

She said recently she completed an inpatient treatment program and had been
"successfully in recovery for almost five years now."

"That whole thing was in the past," she said. "I corrected it."

Arkansas officials said Bennett participates in the state's Pharmacy
Support Group, a program that includes random drug screening, monthly group
meetings and weekly contact with a monitor. Bennett's drug screens have
been clean, said Charles Campbell, the board's executive director.

In the last six months, Arkansas officials have referred six to eight
pharmacists to the support group, Campbell said. The group is very active
and maintains rigid rules, he said.

"We sorely need (it)," he said.