Forensic Pharmacist and his roles & responsibilities - Forensic Pharmacy

Forensic Pharmacy & Forensic Pharmacist

Forensic: Application of science for detection of crime.

Forensic Pharmacy: Forensic Pharmacy is the application of drug sciences to legal issues.

Forensics should not be confused with thanatology (study of death)

Pharmacists have been involved in a variety of leadership roles in the field of forensics. Pharmacists have been doing medicolegal work and law enforcement work for years. The only aspect of forensic pharmacy that is new is the terminology.

Forensic Pharmacists engage in professional work relating to litigation (the conduct of a lawsuit), regulatory affairs and process, and the criminal justice system. Domain of forensic pharmacy includes clinical, distributive, administrative aspects of pharmacy and basic pharmaceutical sciences.

Forensic Pharmacy is a vast field. It overlaps with many other forensic fields e.g., forensic medicine, forensic psychology, forensic toxicology, forensic accounting, fraud examination, forensic chemistry, forensic document examination, polygraph examination (the lie detector), death investigation, forensic nursing, forensic optometry, and accident reconstruction (forensic pharmacist helps in determining the role of drugs or medications as a contributing factor to the accident). In fact, almost every profession has a forensic application. It can also be said that almost every specialty of a profession has a forensic role.

Almost every pharmacist does some type of forensic work whether he or she realizes it or not.

ü  A community pharmacist needs to scrutinize a prescription for possible forgery.

ü  A pediatric pharmacist may watch for signs of child abuse.

ü  A hospital pharmacist develops systems to detect and prevent drug diversion.

ü  A nuclear pharmacist may serve as radiation safety officer.

ü  A psychiatric pharmacist may monitor patients for signs of substance abuse.

Specific issues involving forensic pharmacists include professional malpractice, patient confidentiality, drug diversion, drank and drugged driving, impaired capacity, drug-induced violence, appropriate use of chemical restraints, adverse drug reactions, drug interactions, product tampering, medication errors, quackery and health care fraud, and poisoning.

The most common consulting forensic role for a pharmacist is that of forensic litigation consultant. Pharmacist can review and educate the lawyer about medication-related issues.

 

Pharmacist Malpractice:

Pharmacist have been sued for many reasons including dispensing the wrong medication, compounding errors, failure to detect interactions, failure to contact prescribers about excessive dosages, and failure to warn patients about side effects. Clinical pharmacists can be liable for improperly monitoring drug therapy.

Malpractice cases against pharmacists generally require testimony from another pharmacist; the exception being an error that is so obvious that even a layperson can understand it without expert testimony.

Most lawyers will not file lawsuits against pharmacists unless an affidavit is obtained from another pharmacist expressing an opinion of negligence. This pharmacist expert witness would express an opinion supporting the allegations of malpractice. The defence may have pharmacists as expert witnesses for rebuttals.

Malpractice against other health professionals:

The forensic pharmacists can assist lawyers regarding malpractice cases of other health professionals, for example physicians and nurses.

Generally, pharmacists cannot testify as to the professional standards of other professionals. However, if the case involves an adverse drug reaction, the pharmacist can testify about causation. He can also testify about alternative therapies with less risk. He can also provide opinions about medications that can prevent disease complications.

For example, if a patient develops renal failure from diabetes or hypertension, the pharmacist can discuss medications that would have prevented or reduced the risk of kidney damage.

Blood levels:

Certain drugs have a narrow therapeutic range and need to be closely monitored (e.g., digoxin, theophylline, lithium, etc.).

Clinical reasons for which to draw blood samples include high doses and borderline doses, signs of toxicity occurring, lack of a therapeutic effect, or suspected poor adherence.

Toxicology analysis is a common part of the forensic autopsy and often forensic pharmacists are consulted to interpret drug levels.

Numerous changes occur postmortem that may increase or decrease blood levels detected at autopsy. The postmortem blood level may not reflect an antemortem blood level.

Drugs, Alcohol, and Driving:

Pharmacists have numerous skills that are useful in driving under influence (DUI) cases.

The forensic pharmacist can interpret the levels of blood alcohol and discuss the typical effects from different alcohol levels.

Pharmacists can apply pharmacokinetics to estimate the level of alcohol at the time of the alleged event. Pharmacokinetics calculations can especially be helpful if an extended time period exists between the incident and time of collection.

Drug Interaction can be relevant to DUI cases. Certain medications can have additive effects with ethanol, that is lower levels of ethanol will produce greater effects. Other medications can alter the absorption or metabolism of ethanol. Certain disease states may make a person susceptible to the effects of ethanol.

Pharmacists can provide input regarding these other factors relating to alcohol consumption such as personal injury cases.

Criminal Cases:

The work of forensic pharmacist may be needed in various types of criminal cases. This includes cases where drug or poison was used as a weapon, or where medications impair the mental capacity of the dependent or victim.

Drugs as a causative factor for aggression have been used as a criminal defence. This defence is more likely to be successful if the drug is a prescribed medication rather than a substance of abuse. This defence is more likely to be accepted with involuntary ingestion rather than voluntary intoxication. Medication effects can be an issue in determining whether a defendant is competent to stand trial.

The effects of drugs on victims are often related to criminal cases.

ü  Medications are often used as agents for suicide and in suicide attempts.

ü  Drugs and poisons have been used as tools for homicide.

ü  Drugs have been used to facilitate sexual assault, especially in dating situations. The most well-known date rape drugs are flunitrazepam, gamma-hydroxybutyrate (GHB), ketamine and alcohol.

In theory, any drug that has sedating, mind altering effects or impairs memory could be used to facilitate sexual assault.

Off-Label/Unlabeled Drug Use:

Can review insurance claims relating to medication therapy, especially where new and unusual uses of medications are prescribed.

Patients, medical professionals, and health care organizations often submit claims to insurance companies, seeking payment for unlabeled uses. This may raise “red flags” with the insurance company.

A forensic pharmacist can review such claims and offer an opinion whether the use is reasonable and common practice.

Off-label use may be brought up in malpractice lawsuits as a standard of care issue. Prescribing off-label medications is in itself not malpractice. Many off label uses of medications are appropriate and medically necessary.

The forensic pharmacist may offer testimony about the need for unlabeled indications and provide insight into appropriate use of that medication.

Fraud and White-Collar Crime:

“Any intentional or deliberate act to deprive another’s money or property by means of deception”

Types of fraud related to forensic pharmacy include:

1.      Scientific Fraud: Submitting intentional false data for publication in a book or journal.

2.      Quackery: The promotion of remedies that lack scientific support to consumers or health professionals.

3.      Drug Diversion: Obtaining controlled substances for misuse or abuse.

4.      Health care fraud: Submitting intentionally false data to insurance companies.

5.      Occupational Fraud and Abuse: This is no way limited to pharmacy and or even the health care industry.

6.      Record Tampering: Improper changes in the writing in the medical records after a lawsuit has been initiated or fear lawsuit after an unexpected occurrence.

7.      Counterfeit drugs

Overlap exists in the above areas. Case reports suggest that some cases of financial fraud may be due to the need to purchase illegal drugs.

 

Lecture notes by Syed M. Ashad Halimi