Regardless of whether you have been taking the same medication for years or were recently written a prescription to treat a short-term ailment, you probably don’t pay much attention to what’s actually inside the bottle. For example, while you may initially read the label or the information that comes with the prescription to verify that it’s correct, chances are very good that you don’t carefully examine all of the pills inside the bottle to verify color, size, shape, etc.

This makes sense because you naturally have a good deal of faith in your local pharmacy, which is staffed by trained professionals and has never made any prior errors regarding your prescription.

However, a recent story out of neighboring New Jersey may cause you to rethink this position.

The Office of the Attorney General of New Jersey recently announced the conclusion of a rather lengthy investigation into the prescription-dispensing practices of one branch of a very popular pharmacy chain. In fact, the AG’s report indicated that, in the process of investigating the one branch, it uncovered dozens of medication mishaps at four other branches.

The initial investigation was launched after officials received five separate complaints that the branch in question had “commingled medications to its customers.” In other words, the complaints revolved around patients’ receiving entirely different medications within the same bottle.

Here, the problem was traced to the appalling practice of pharmacy staff’s taking prescriptions that customers had neglected to pick up and putting them back into their larger containers on the pharmacy shelves for reuse. Specifically, this practice — which was a clear violation of company policy — resulted in pharmacy staff’s putting the wrong medications into the wrong bottles, creating commingled medications.

While company policy dictates that the supervising pharmacist verify the contents of each prescription by pouring a few of the tablets into the lid, this evidently did not catch the problem.

During the course of the investigation, the AG’s office ordered the pharmacy chain to disclose any other errors at its statewide stores during the preceding year. It was thus that the investigators determined that the problem of commingled medications was occurring at four other branches.

Some of the reported prescription errors included:

• Pills to treat breast cancer were commingled with chewable fluoride tablets for children
• Pills to treat schizophrenia were commingled with pills to treat high blood pressure
• Pills to treat diabetes were commingled with pills to lower cholesterol, which resulted in a trip to the ER for one patient

In lieu of civil litigation, the pharmacy chain ultimately agreed to a deal in which it will improve quality control measures, retrain staff and pay a significant fine of $650,000.

Thankfully, no one was seriously injured by these truly shocking medication errors. Here’s hoping that the necessary changes are implemented and that all pharmacies — no matter their size — put patients first.

Source: The Star-Ledger, “CVS agrees to pay $650,000 after giving customers wrong prescription pills,” Amy Ellis Nutt and Christopher Baxter, Feb. 25, 2013