Killing Compounds and Workers' Comp

Wednesday, October 24, 2012 | 0

When will we hear of the first workers' comp claimant to die from a faulty compounded drug? Has it happened already?

This isn’t hyperbole – compounded drugs have blinded victims and killed before – a  young woman using a topical anesthetic, a patient treated for pain, nine deaths from defective solutions produced by an Alabama compounder, and the most recent – and worst – outbreak of meningitis.

In all, there have been at least 200 “adverse events” involving 71 compounded products over the past 20 years. Yet lax – or non-existent – regulation continues to this day. Compounding pharmacies are regulated (for the most part) by the states. The reality is many states are poorly equipped to deal with the issue, and many states really don’t do much to regulate/monitor/enforce regulations related to compounding pharmacies.

This from Michael Cohen, an expert on the issue:

Compounding pharmacies should be testing and monitoring the environment in which products are compounded, training and closely supervising staff, adhering to the recognized standards for compounding safety that were formulated by the United States Pharmacopeia (in Chapter <797> of the USP) and detecting process deviations before they cause harm. Yet, an analysis of recent cases of contamination of products from compounding pharmacies that have led to adverse health outcomes revealed that breaches of standards, unsafe staff behaviors, untrained and unskilled personnel, improper use of equipment, extended beyond use dating, outside of manufacturer labeling without sufficient testing, and/or a general lack of good compounding skills had been involved in almost all cases. … Without federal oversight and/or greatly improved state oversight of compounding pharmacies, patients will continue to be harmed.

So … why aren’t the Feds more involved?

Glad you asked. Turns out there have been repeated efforts to increase oversight of compounding pharmacies, however they have been stymied by effective lobbying from, among other groups, the International Academy of Compounding Pharmacists.

The IACP claims “compounded medicines are a critical part of modern, individualized health care and provides them the necessary tools to ensure that access to personalized medication solutions remains possible,” yet they’ve been instrumental in successfully blocking federal regulation of “mass-compounding” through an effective lobbying campaign involving Congress.

While compounding advocates talk about the need for individual, customized medicine, they lobby to prevent oversight of what are really drug manufacturers masquerading as compounders.

The result is now evident – 23 dead patients, and more may be coming.

For workers' comp, the implications are clear. The drug produced by NECC is used in treating back pain via epidural steroid injection, an all-too-common procedure in comp. As of now, there are 281 infected patients, and with an incubation period of up to six months, many thousands of patients are agonizing over their potential fate.

What does this mean for you?

If you are a workers' comp payer,

•     Figure out if any of your claimants may be at risk. The list of affected facilities is here.
•     Search for the facility name in your medical bill data, along with the CPT codes associated with ESI.
•     Identify any claimants that may have been affected, and get your medical director and nurse case managers involved.
•     Get your subro folks involved.
•    Oh, and tell your Governmental Affairs people to ask Congress to fix the oversight problem. Unless you want to repeat this process again.