Policy

Ohio bill would criminalize non-reporting of serious pharmacy mistakes

Senate Bill 119 would require pharmacists, pharmacy interns and technicians to report mistakes related to dangerous drugs within two weeks to the state Board of Pharmacy. Not doing so would be a fourth-degree misdemeanor, according to the bill.

COLUMBUS, Ohio — Recently proposed state legislation would criminally punish pharmacy staff who didn’t report errors related to dispensing dangerous drugs to patients.

Senate Bill 119 would require pharmacists, pharmacy interns and technicians to report those mistakes within two weeks to the state Board of Pharmacy. Not doing so would be a fourth-degree misdemeanor, according to the bill, which now is in the Senate’s Health, Human Services and Aging Committee.

State Sen. Tim Grendell, the bill’s primary sponsor, said he created the legislation to eliminate under-reporting of errors and make the pharmacy board a central repository for such information.

“I want this to be a measure for the pharmacy board so they can take remedial corrective action to help avoid serious physical harm or death,” Grendell said.

National non-profit groups and state boards collect information voluntarily, but there’s no requirements to do so. In Ohio, serious errors are sometimes reported by pharmacies but most errors are reported by patients and physicians, Pharmacy Board Executive Director Bill Winsley said.

“We’re not hearing about all the errors,” Wensley said. “I’d like to say we’re hearing about all the serious errors. But I cannot even say that.”

There’s an increasing focus on the best way to prevent and punish pharmacy errors in the wake of the death of Emily Jerry, a 2-year-old who died in 2006 after a technician mixed and a pharmacist approved a bad mix of chemotherapy solution.

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The state last year passed Emily’s Law, legislation also sponsored by Grendell, that created licensing and minimum education requirements for pharmacy technicians. The pharmacist who approved Emily’s deadly mix, Eric Cropp, pleaded no-contest last month to involuntary manslaughter and will be sentenced in July.

Industry advocates have said pharmacists shouldn’t be punished criminally for accidents. Instead of punishment, some pharmacy groups have said offering immunity for most mistakes — a model used by the Federal Aviation Administration — would increase reporting and lead to faster, and more lasting, effective change.

“I’m getting concerned that we’re going to go after safety, and doing it in a way that the pharmacist is an adversary of the person collecting data,” said Ernest Boyd, executive director of the Ohio Pharmacists Association. “That won’t get us to the real root of the problem.”

Grendell said he’d consider an immunity approach. “I’m open to any proposal that will create an environment where the pharmacy board will have the information necessary,” he said. “My goal is not to do a witch hunt, but to have a safe environment for Ohio patients.”

The legislation also is structured primarily to avoid civil suits. Reported errors would not be public documents — an approach Grendell said would keep the data from becoming “the ultimate personal-injury research tool.” However, after going to the pharmacy board, the errors could be used by law enforcement officers to criminally prosecute pharmacists.

Grendell said he’d like passage of the legislation in about 18 months.

[Front-page photo courtest of Flickr user prudencebrown121]