Trusting the Man in the White Coat

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KMBC-TV/AP

Robert R. Courtney, a wealthy pharmacist accused of diluting cancer drugs

Imagine you are diagnosed with cancer and after discussing your options your oncologist schedules chemotherapy. The drugs, carefully calibrated to be just toxic enough to kill the cancer cells without completely killing you in the process, are your best chance for survival, even recovery.

Now imagine you’ve endured the treatment, hoping for the best, and your doctor calls you with terrifying news: The pharmacist who made your treatment has been accused of diluting chemotherapy mixtures down to 1 to 39 percent of their prescribed strength.

Monday, a federal judge considered that nightmare scenario as he presided over a hearing for Robert Courtney. The Kansas City pharmacist, who allegedly diluted the chemotherapy treatments for at least 35 patients, is charged with one federal count of adulterating and misbranding drugs. Courtney, who is reportedly worth at least $10 million, has admitted to investigators that he’d diluted the expensive drugs "out of greed and in order to make more money." If convicted, he could face a $250,000 fine and a three-year jail term.

Lawyers associated with the case predict Courtney could face a much harsher sentence if prosecutors decide to pursue each patient’s case separately. And even more penalties could come if the government could show that someone died as a direct result of Courtney’s actions.

Given the grim statistics and unpredictability facing cancer patients, of course, it will be difficult, if not impossible, to establish a direct cause and effect relationship between Courtney’s alleged criminal activity and a specific death. But, says Dr. Joan Bull, professor and director of medical oncology at the University of Texas Medical School at Houston, it should not be difficult to show that Courtney inflicted harm: "These patients were going through their therapy, assuming they were getting the right dose, and all the time they weren’t getting an anti-tumor response."

Courtney’s actions, Dr. Bull adds, could easily have thrown off the intricate timing of cancer treatment. "This is a fairly dire scenario in that chemotherapy drugs are most effective against tumors at the highest dose you can get in without toxicity, and the patients who received dosage from this pharmacist obviously weren’t getting that potency."

What does the future hold for Courtney? Even if the criminal charges don’t stick, he’s probably not looking at a particularly bright forecast. Susan Winckler, a spokesperson for the American Pharmaceutical Association says that even if the Missouri state board of pharmacy doesn't vote to revoke his license, she very much doubts he will just slide right back into his white coat when all this is over. "Nothing like this has ever happened before," Winckler says. "Pharmacists are bound by a code of ethics, and an oath — they’re bound to hold patients above everything."