Historically in the United States, most community pharmacists operated informal pharmacy crime information networks. These networks usually were local telephone call lists or "telephone trees," whereby pharmacists verbally contacted each other in a relay fashion with important crime-prevention warnings or alerts. Pharmacists and doctors used these information networks to identify and prevent criminal activity, including prescription fraud, forgery, and robbery.
With the enactment of the Health Insurance Portability and Accountability Act (HIPAA) and the fear of lawsuits for disclosing protected health care information, these networks largely fell into disuse. Such was the case in St. Joseph County, Indiana. As a result, criminals were free to prey on local pharmacies. In 2003, however, because of an alarming and increasing number of local and statewide armed robberies of pharmacies, the members of the St. Joseph County Pharmacy Association (SJCPA) in desperation felt the need to do something locally.
Crime Watch Formation
In December 2003, with information from and at the suggestion of the South Bend Police Department (SBPD) and Rx Patrol (www.rxpatrol.org/), the SJCPA formed a Pharmacy Crime Watch, in cooperation with all local law enforcement agencies (South Bend, Mishawaka, and St. Joseph County). It was learned that police reports are public-domain documents and exempt from HIPAA, and thus they are a tool for the communication of information on pharmacy-related local criminal activity. A distribution system similar to a previous telephone call network was developed for distributing (by facsimile) hard-copy written police reports, notices, and warnings.
Initially and for a period of about 2 to 3 months, we had no reports. Then, after repeated encouragement at our monthly meetings for pharmacists to step forward and make reports, we started having success.
Most important, local pharmacists received feedback notices of outcomes - that arrests were being made and that local law enforcement was supporting the pharmacists. Police officers and the county prosecutor attended and gave brief presentations at our SJCPA meetings. Two successful pharmacy armed-robbery arrests and other local arrests for prescription fraud further solidified this support. (One rather dramatic event involved a police vehicle chase, followed by an on-foot K-9 unit chase and arrest.)
Despite this success, some participants were still concerned about the risk of HIPAA violations. For this reason, early in this effort we contacted the Department of Health and Human Services (HHS). After a considerable period of time, and ultimately with the assistance of Indiana Senior Sen Richard Lugar, we received positive responses from HHS and eventually from the US Department of Justice.
The true rate of pharmacy armed robbery and prescription fraud is often difficult to determine, because accurate statistics are not maintained by local and state police or the FBI. In 2003, Rx Patrol, a national, voluntary reporting system, was established, and it is the most comprehensive source of data to date. Figures 1 and 2 show data collected from St. Joseph County area police agencies and the Rx Patrol database. The rate of armed robbery and prescription fraud immediately before and after the initiation of the SJCPA Pharmacy Crime Watch in 2004 is shown.
Clearly, a drop in armed robberies is seen, along with a rise in prescription forgery/fraud arrests and reports, while statewide robberies and burglaries were increasing. In 2005 and 2006, St. Joseph County did not have a single armed pharmacy robbery. In comparison, we averaged one every other month in early 2003, and this number and events statewide were the spark that stimulated our action.
The success of our local Pharmacy Crime Watch has attracted the attention of local physicians and the media. As a result, the St. Joseph County Medical Society has joined this effort and receives these notices. Media attention is very important, as we have seen a dramatic drop in fraud attempts each time a story has been aired on local television. This lull in crime activity seems to last about 3 to 6 months.
The program now has contributed to 27 arrests and has prevented even more crimes. Pharmacists in St. Joseph County are now stepping up and reporting prescription fraud that might have gone unreported previously. Neighboring counties have seen an increase in prescription forgery, as repeat offenders have moved because they do not want to risk rearrest in our county. Elkhart County also has started a Pharmacy Crime Watch, and we are in contact with 4 other surrounding counties that have not yet fully organized a Crime Watch.
Our success is further illustrated by 2 events in St. Joseph County:
1. A local pharmacist recognized a customer as a fugitive cocaine dealer. She called police and delayed filling the prescription. An arrest was made.
2. US marshals asked us for assistance in locating an "armed and dangerous federal firearms fugitive" using local pharmacies. A brave area pharmacist identified this person and called law enforcement with information. An arrest was made by the marshals.
Pharmacists have an inherent duty to report prescription fraud and forgery attempts so as to protect the drug supply and prevent diversion. A Pharmacy Crime Watch encourages pharmacists to report fraud and forgery attempts, share the information with other pharmacists, and alert others of ongoing and potential fraud and theft threats. The techniques, methods, and names of repeat and potential offenders also are gleaned from these reports. The reports make pharmacists "streetwise" and alert for diversion schemes and robberies.
The arrests and media attention have sent a message to area criminals, and, as a result, reported forgery and fraud attempts have now decreased and the pharmaceutical drug supply has become more secure. Last year and again this year, we have recognized and rewarded noteworthy pharmacists for their courageous acts, with a framed certificate of recognition from the SJCPA. We hope to make the bestowal of this award an annual event.
Campanelli RM, director, US Department of Health and Human Services. Letter to Indiana Sen Richard Lugar on Pharmacy Crime Watches, 12/1/05 (document 06-43908; 05-3571).
Department of Health and Human Services: Summary of the HIPAA Privacy Rule. Available at: www.hhs.gov/ocr/privacysummary.rtf.
Moschella WE, assistant attorney general, US Department of Justice. Letter to Indiana Sen Richard E. Lugar on Pharmacy Crime Watches, 2/2/06.
Pharmacy Crime Watch: recommendations for starting a local effort. White paper by Ken Fagerman, RPh, MM. E-mail at: firstname.lastname@example.org.
Rx Patrol Web site. Available at: www.rxpatrol.org.
Tips and suggestions for pharmacists on how to handle known or suspected prescription fraud. White paper by Ken Fagerman, RPh, MM. E-mail at: email@example.com.
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