Greenville Pharmacy at 2705 Correctionville Road in Sioux City, Iowa. (Photo via Google Earth)
State regulators have issued an emergency, indefinite suspension of the license of a Sioux City pharmacy they say poses “an immediate danger to the public health.”
According to the Iowa Board of Pharmacy, Greenville Pharmacy of 2705 Correctionville Road in Sioux City, repeatedly dispensed incorrect prescriptions between October 2023 to August 2024, failed to improve its dispensing protocol to ensure the prevention of medication errors, and failed to comply with board orders issued in past disciplinary cases.
The case marks the third time Greenville Pharmacy has faced licensing action due to allegations of incorrectly dispensed medications.
Earlier this year, the board entered into a settlement agreement with Greenville Pharmacy over findings that on Oct. 4, 2023, it had incorrectly filled a patient’s prescription, which resulted in the patient being treated in an emergency room and then hospitalized with a life-threatening condition caused by the medication error.
The board now alleges that the pharmacy has failed to comply with that settlement agreement by failing to provide adequate documentation in support of its Continuous Quality Improvement program. The board alleges that on May 1, 2024, a male patient picked up what he thought was his prescription medication, noticed it was incorrect before ingesting it, and returned it to the pharmacy five days later.
The pharmacy’s owner and staff pharmacist did not alert the pharmacist in charge of his error, the board alleges. Although the owner and staff pharmacist allegedly realized the male patient’s correct prescription was likely provided to a female patient, resulting in a second prescription-filling error, that second error wasn’t corrected. The female patient took the incorrectly dispensed medication and on May 29, 2024, she allegedly experienced an adverse reaction and required emergency room treatment.
Then, on Aug. 15, 2024, another patient received two prescriptions from the pharmacy, both of which were verified by the pharmacist in charge. One of the two prescriptions was incorrectly filled, the board alleges. At 6 p.m. that evening, the patient allegedly took both medications as prescribed and immediately began to experience adverse symptoms.
The pharmacy is now charged with seven regulatory violations: professional incompetency, engaging in unethical conduct or practices harmful to the public, willful or repeated malpractice, willful or gross negligence, failing to create and maintain complete and accurate records, dispensing incorrect prescriptions, and violating a lawful order of the board.
A hearing on the matter is scheduled for Dec. 2, 2024.
Greenville previously cited for errors
State records show that in 2002, the board charged Greenville Pharmacy with violating a law related to the practice of pharmacy and with the intentional or repeated violation of board rules.
As part of that case, a board investigator reviewed the records of all the controlled substances dispensed by the pharmacy between September 2001 and January 2002, and found that the business had provided customers with controlled substances before the “do not dispense before” date nine times during the four-month period.
The board also alleged the pharmacy had dispensed six prescriptions for controlled substances when the prescription was undated or was dated at least 15 years prior to it being filled. Pharmacists at the business allegedly acknowledged that they believed several customers who regularly had their prescriptions filled prematurely were abusers of controlled substances.
The case was resolved with a consent order requiring Greenville Pharmacy to pay a $1,500 fine, with its license placed on probation for three years.
In 2005, the board charged the pharmacy with a lack of professional competency due to a medication-dispensing error, failure to perform the required inventory of controlled substances, and failure to comply with the terms of the 2002 consent order.
The board alleged that on some unspecified date, the pharmacy had incorrectly dispensed Toprol-XL, a beta-blocker used to treat high blood pressure, rather than Topamax, a drug used to treat epilepsy that had been prescribed for a 5-year-old child.
A routine inspection then revealed that no inventory of controlled substances had been completed over the previous three years. The board fined Greenville Pharmacy $500 and its license was placed on probation for three years.
State records indicate that two pharmacists, Robert E. Rehal, 91, and Robert P. Rehal, 57, are officers of Greenville Pharmacy.
In 2002, Robert E. Rehal’s license was placed on probation for three years in connection with the allegations of medications being dispensed prematurely.
In 2005, Robert P. Rehal’s license was placed on probation for three years in connection with the Toprol-XL dispensing error.
In 2017, Robert P. Rehal, as the operator of Leeds Pharmacy in Sioux City, was charged with violating the duties of a pharmacist in charge. The board alleged Rehal’s quality-improvement reports that pertained to dispensing errors did not “adequately address the root causes of dispensing errors.” Rehal was issued a warning, fined $500, and was required to complete 18 hours of educational training on medication errors and patient safety.