Letters to the editor: October 22, 2007

Lesson from patient death: Stay vigilant

In your Sep. 17 issue, I read with sadness and dismay a report about the death of a child at Rainbow Babies & Children's Hospital in Ohio as a result of erroneous administration of a super-hypertonic and concentrated (23.4%) sodium chloride solution, instead of 0.9% sodium chloride as a base solution for a chemotherapeutic medication. With sadness, because a precious life was lost due to an avoidable administration of a potent and fatal solution; with dismay, because the manslaughter charge of the pharmacist involved in the case (if there was no clear intent) would not be a deterrent of future similar mishaps. On the contrary, as correctly pointed out by Michael Cohen, such indictment may "discourage others from reporting errors" of similar or less consequential nature for fear of legal punishment.

There is obviously no easy fix for potential medication errors. For the most part, they are a result of systemic deficiencies. From the broad public point of view, in addition to the legal ramifications, sentinel events of such fatal magnitude may tarnish, perhaps unwarrantedly, the image of not only a particular health worker, be it a pharmacist, a physician, or a nurse, but also a whole profession, a healthcare institution, and by extension the very core of the healthcare delivery system. That is precisely why strict adherence to preventative regulatory guidelines plays a pivotal role in patient safety. The whole mechanism of patient safety is a continuum, an ever-evolving process, especially as healthcare delivery becomes more complex. This sad case behooves all healthcare workers to always be vigilant, even in the face of "rush" and emergency.

We need one price for all

I agree with Michael Rupp (Viewpoint, Sept. 3) that it is time to overhaul our drug reimbursement system. Since Medicare Part D has been implemented, the number of times I've been forced to fill a prescription at below my acquisition cost has gone up by 700%. It's funny how this never happens with a cash customer. It seems to happen only with third-party plans. We definitely need transparency and we know that the CMS-proposed AMP model is a potential catastrophe.

Mr. Rupp's proposed model of Payment = Product cost + Cost to provide drug + Fee for services + Performance incentives might improve quality of care, ensure a pharmacy profit, and ensure patient access to that care. But, I don't think it goes far enough.

The problem lies in the product-cost part of the equation. It's why CMS' AMP formula fails to work. Everyone has a different product cost. Mail order, the VA, nonprofit hospitals, big drug chains, and even other countries like Canada have been able to negotiate discounts, rebates, or kickbacks that make their product cost far different from what the average small town independent pharmacy can obtain.

If we're going to overhaul the system, let's eliminate all of these discounts and implement a one-price-for-all system. Whether you are the VA, hospital, a mail-order facility, chain drugstore, or independent pharmacy, you purchase drugs at the same price as all of the others. Level the playing field for everyone!

Local pharmacies could easily compete with out-of-state mail-order plans if their drug cost was the same. Even the 90-day supply at retail programs would be financially feasible. Patients would flock to the pharmacies that provide the best care since pricing issues would be negligible. People would be content to utilize one pharmacy for all of their medicine rather than sacrifice safety for the incentive of lower prices or co-pays elsewhere. Why, quality of care would actually improve, wouldn't it?

Sounds like a pipe dream, doesn't it? The skeptic in me fears there are too many entities with their powerful hands in the cookie jar to see this happen in my lifetime. But if we're ready for a complete overhaul, why not go all the way?

Douglas Heidbreder, R.Ph.
Onsted, Mich.
rph007@comcast.net