Take care at the pharmacy: This article below may not be about PD, but it is about safety at the pharmacy.

To preface this article: In January I went through the drive-thru at my local Rite Aid. When the tech came to the window with my bottle of carbidopa/levodopa I knew something was wrong right away and commented, "that bottle is certainly small". The tech said, "This is only a partial, the rest will be here tomorrow." Okay I thought. But I was reassured by her comment. Full or not full, I knew it should be a larger bottle considering the number of C/L I take every month.

I took the bag and drove forward a bit, since someone was behind me in line. I opened the bag and read the label on the bottle..."Teva, round, yellow" Well, that part was correct. Now keep in mind that ANYTIME (in the USA anyway) that a pharmacy "substitutes" one "brand" for another, they are suppose to verbally notify the customer; e.g. Pfizer subed for Teva. So, I opened the bottle...not only did the bottle looked to small, but the rattle sound wasn't right either. Inside the bottle was not Round, Yellow pills, but oval shaped blue pills.

I got back in line and told the tech that I had the wrong medication. She left the window and spoke to the Phamamcist, who came to the window and told me that they didn't have the Teva "brand" (these are actually generics I am buying) in stock and were giving me what they had. Okay, left the pills and they filled them another day with Teva "brand."

In February, I picked up my monthly refil and again the bottle said, "Teva, Round, Yello" but the contents was not the usual Teva pills. I didn't notice this at the window, since they were in the usual larger container. When I got home and opened the bottle, I found a pill I had neve seen before, and I have been taking C/L for many years now. I called the pharmacy and spoke to a Pharmacist, who was not happy with my call...say who is the custoemr here...he told me that they weren't going to carry the Teva "brand" any longer since too many of them broke in the bottle during shipment. I commented that this meant that I would have to buy a pill cutter, which I didn't want to buy. I didn't make the comment because the purchase was a hardship, but becaue many time using a pill cutter shatters the pill. He biligerntly said back to me, "If you will identify yourself when you come in to make the purchase, I will give you one for free."

So, pay attention to your meds and question substitues, or apparent substitutes...that is if you already don't.

Here is a website you can go to to see Images and other information about any medication on the market.
For Example, this is the Sinemet Oral Drug Image page

The first image of carbidopa/levodopa 25/100 is what I have gotten for years.
The third image of C/L is what I received in February.
What they tried to give me in January is NOT in these images.

Each drug has a small Table of Contents:

* Uses and How to Use
* Precautions and Side Effects
* Dosage and Storage
* Drug Image

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Many lawsuits against pharmacies settled in silence

by Erik Brady and Kevin McCoy, USA TODAY
http://www.usatoday.com/news/health/...-secrecy_N.htm

Chanda Givens wanted to ensure the health of her unborn child when she became pregnant last February. Her doctor prescribed a prenatal vitamin, Materna. But instead, a Walgreens (WAG) store in suburban St. Louis gave her Matulane, a chemotherapy drug that interferes with cell growth.

According to the federal lawsuit she later filed against Walgreens, Givens, then 29, suffered weeks of "nausea, vomiting, neurologic symptoms … dizziness, lightheadedness, chills and shortness of breath." A medical exam showed her fetus was not developing normally. She miscarried in early April.

She said the loss of her baby was a direct result of Walgreens' giving her the wrong drug, and she and her husband, Courtenay, sought actual and punitive damages in excess of $75,000. Her attorneys contended Walgreens failed her on multiple levels in terms of supervising its personnel and verifying the prescription with her doctor.

Was Walgreens really to blame? What caused the error? There is no way to know: The case was settled out of court a few weeks after the lawsuit was filed. Givens, her husband and her attorneys now cannot talk about it publicly because they signed a confidentiality agreement.

USA TODAY found a number of lawsuits that alleged corporate malfeasance in cases of pharmacy errors at Walgreens and CVS. Many were settled, and nearly all the settlements included confidentiality agreements.
FIND MORE STORIES IN: St. Louis | Walgreens | Carmen Catizone

"Settlements buy silence," attorney J. Douglas Peters says. "Attorneys have an ethical Catch-22: They have a duty to their client and a duty to the public good. But their first duty is to their client. And if the client is going to get paid, the big-box pharmacies insist on silence."

That's why Peters, who practices in Detroit, is unable to talk specifically about individual cases of pharmacy errors he has settled over the years. But he says he has seen a pattern in which drug chains settled cases after they were asked to produce data revealing what happens behind the drug counter, such as how many prescriptions pharmacists are expected to fill in how much time.

The reasons for confidentiality

Barry Furrow, director of the health law concentration at the Drexel University College of Law, says pharmacies have two major reasons to insist on confidential settlements. First, to avoid bad publicity in a field where public trust is important. Second, to keep potentially damaging information from plaintiff lawyers.

The problem, Furrow says, is such agreements make it difficult to detect patterns of errors at pharmacies, though it's in the public interest to know if they exist. Furrow, a law professor, writes textbooks on health law. "There's a whole world of research that's very hard to do," he says. "It is hard to find out much of anything, even if I talk to lawyers, because they can't tell me much. It's hard to spot patterns and see what's going wrong."

Walgreens challenges the notion that it typically asks for confidentiality in settling such cases. "Rather than a strict policy," the chain said in a written statement, "we consider each case as unique and handle it individually."

CVS, (CVS) which also answered in a written statement, said: "Confidentiality agreements are a common practice for all businesses in commercial transactions and in litigation. By including the confidentiality provision, CVS follows standard procedures typical for resolution of any liability claim."

Michael Krauss, who teaches legal ethics at George Mason University Law School, says it's true confidentiality is agreed to "in the majority of tort suits," particularly when a company's or an individual's reputation is at stake, as in medical or pharmaceutical malpractice. "If you and I agree to make a contract, we can condition that contract on secrecy," Krauss says. "And that's all a settlement is, a contract. Remember, there is no (court) judgment — it is a voluntary payment."

Legislatures fear crowded courts

Reformers argue that when litigants "avail themselves of the state dispute mechanism, they should have to pay the publicity price," Krauss says. But he says legislatures are loath to change the rules because they fear many more cases would go to trial and crowd the courts.

"The tricky thing" in cases involving pharmacy errors, Krauss says, "is many people believe the public health is involved. It seems a little bit like extortion. It's not exactly that, but it seems like money for silence."

Detroit attorney Peters describes "two levels of secrecy. One is confidentiality. But even before you get to a settlement, there is the protective order, which most companies will ask for (in court) as a precondition to produce documents." The reason drug chains give, he says, is to keep "trade-secret stuff" from competitors.

Walgreens was required to supply recent prescription-error data chainwide in a Tennessee federal lawsuit filed by the family of Trey Jones, a 5-year-old mistakenly given an anabolic steroid. But U.S. District Court Judge Aleta Trauger granted Walgreens' motion for a protective order. She wrote that lawyers for Jones' family were entitled to the information for purposes of pretrial discovery, "but not for purposes of making a publicity 'splash' against the defendant."

A typical settlement includes boilerplate language such as this: Terms are "confidential and are not to be publicized, revealed, disclosed or discussed directly or indirectly with any representative of the print or electronic media, or to any professional or trade publication or organization."

This wording was provided by an attorney who asked not to be identified for legal reasons. He says drug chains never admit culpability when paying out settlements. He cites a typical clause that characterizes a settlement as "a compromise of doubtful and disputed claims, that payment … is in full accord and satisfaction of any and all claims (and) is not to be construed as an admission of liability, but on the contrary, the parties released expressly deny any liability … and intend merely to avoid the costs and expenses associated with litigation."

Errors are generally not made public by state pharmacy boards unless disciplinary action is taken — even in cases of death or serious injury — according to Carmen Catizone, executive director of the National Association of Boards of Pharmacy.

North Carolina is the only state that makes public all errors involving death or serious injury, he says, adding that his group has tried for 10 years to persuade other states to mandate such reporting. After significant errors such as the Givens case make news, there are demands that errors be tracked. "But once that initial outrage dies down," Catizone says, "the issue is left to politics. Then we lose."

As for Givens, one of her attorneys told the Associated Press in October it's uncertain if taking a chemotherapy drug could affect her long-term health. What is certain is she lost what would have been her second child. "It's been a nightmare," she told KTVI, a St. Louis television station.

That was before settlement.

Now she says nothing.