FDA warned syringe producer of serious problems
By MIKE BAKER
Associated Press Writer
RALEIGH, N.C. (AP) — Federal regulators warned a syringe manufacturer of “several significant violations” in its quality control system two years before its needles triggered an outbreak of bacterial infections that prosecutors say led to at least five deaths and hundreds of illnesses.
A U.S. Food and Drug Administration warning letter, made public Thursday by the agency, cited AM2PAT Inc. in August 2005 for nine serious violations at its factory in Raleigh, where it made syringes of heparin and saline to flush IV lines.
The company, which was incorporated in Chicago, later moved its manufacturing to Angier, about 20 miles south of Raleigh.
Among the problems at the Raleigh factory, the letter noted poor documentation of sterility tests, insufficient efforts to maintain a sterile environment and unqualified workers. Each of those issues were cited again this month as prosecutors won guilty pleas from two former AM2PAT employees and charged former CEO Dushyant Patel.
Authorities are searching for Patel, who may have fled to his native India. Prosecutors do not know if he has an attorney. He faces up to 95 years in prison if convicted on 10 charges including fraud, false statements and selling adulterated medical devices.
The 2005 warning letter said the failure to establish and maintain procedures to control the environment “could reasonably be expected to have an adverse effect on product quality.” It said the company’s written quality control procedures were “obsolete” and there was no sign workers had been properly trained.
“Evidence of improperly trained personnel included an employee chewing gum while filling syringes and an employee improperly gowning during sterility testing,” the warning letter stated.
Those issues apparently lingered. Prosecutors have said that the company’s “microbiologist” was a teenager who had dropped out of high school. Photographs introduced as evidence show a “clean room” with a window fan patched with duct tape. Others show paint chipping off the facility’s floor and syringes piled high on a table.
But the criminal case particularly focuses on how the company documented its shipments. Prosecutors contend the company was so consumed with maximizing profit that it shipped syringes without testing to ensure it they were sterile, and then later backdated paperwork to make it look as if the company had followed procedure.
AM2PAT vowed in 2005 to correct its deficiencies, according to the warning letter, and the FDA said a follow-up inspection in January 2006 was satisfactory.
On Wednesday, the FDA said the next inspection didn’t take place until December 2007, and court documents show it didn’t happen until after the Centers for Disease Control reported an outbreak of illness connected to AM2PAT syringes. Prosecutors say the product killed five and sickened up to 300 others, with some of the illnesses resulting in spinal meningitis and permanent brain damage.
On Thursday, the FDA said it discovered it also conducted an inspection in August 2007, after the company moved to Angier, and found only a labeling problem.
But that month, the FDA started receiving reports of dirty syringes. Some reported “orange specks” floating inside the unopened syringes, while others reported “yellow sediment” or “muddy brown” syringes filled with floating white specks.
The FDA has declined to release its inspection reports, saying they are only available through a Freedom of Information Act request, which is pending.
Plant manager Aniruddha Patel, 43, of Carpentersville, Ill., and quality control director Ravindra Kumar Sharma, 54, of Richmond, Va., each were sentenced Monday in U.S. District Court in Raleigh to 4 1/2 years in prison for fraud and allowing tainted drugs into the marketplace.
Copyright 2009 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
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Timeline: Reports, inspections of syringe factory
By The Associated Press
Court documents and federal officials say a North Carolina syringe factory linked to hundreds of sicknesses and five deaths went for almost two years without an inspection despite a series of complaints about dirty needles. Here’s a timeline of when the complaints and inspections took place:
2005
— June: U.S. Food and Drug Administration inspects Chicago-based AM2PAT Inc.’s facility in Angier, N.C.
— Nov. 15: FDA receives complaint that someone found particles inside a heparin solution manufactured by AM2PAT.
2006
— January: FDA inspects AM2PAT.
2007
— March 20: FDA receives a complaint that a patient’s husband saw “both brown and black particulate matter found throughout unopened flush syringe.” The patient was hospitalized with a blood infection. The company later said the sample was not available for evaluation but that it tested samples from the same lot. FDA records do not show those results.
— May 1: FDA receives a complaint that “white particulate matter of various sizes” was found in multiple syringes produced by Sierra Pre-Filled, another name for AM2PAT.
— June 6: FDA receives a complaint that “white precipitate or powder” was found in syringe produced by Sierra Pre-Filled.
— Aug. 24: FDA begins receiving a series of almost a dozen complaints of “muddy brown,” yellow, orange and “dingy” syringes, some with debris.
— Dec. 11: The Centers for Disease Control and Prevention advises the FDA of two clusters of infections linked to flushes produced at AM2PAT. Prosecutors say the tainted lot sickened hundreds and killed five.
— Dec. 13: FDA initiates inspection of AM2PAT.
— Dec. 20: AM2PAT issues nationwide recall of product found to be contaminated with bacteria.
2008
— Jan. 18: AM2PAT expands nationwide recall of syringes.
— April: Prosecutors file criminal complaints against two AM2PAT workers.
2009
— Feb. 19: Prosecutors indict AM2PAT CEO Patel Dushyant on a range of charges and begin international search for him. Authorities believe he fled to his native India.
— Feb. 23: Former AM2PAT plant manager Aniruddha Patel, 43, of Carpentersville, Ill., and quality control director Ravindra Kumar Sharma, 54, of Richmond, Va., are sentenced to 4 1/2 years in prison each for fraud and allowing tainted drugs into the marketplace.
___
Sources: U.S. Food and Drug Administration; court documents.
Copyright 2009 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
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Feds searching for CEO in case of tainted syringes
By MIKE BAKER
Associated Press Writer
RALEIGH, N.C. (AP) — For months, prosecutors say, technicians in the gloom of a run-down North Carolina plant prepared life-sustaining syringes and shipped them before ensuring they were sterile.
Investigators believe a rush to maximize profits led Dushyant Patel’s AM2PAT Inc. to produce heparin and saline syringes that killed five people and sickened hundreds of others, some resulting in spinal meningitis and permanent brain damage. Authorities are now on an international search for Patel after he was indicted last week on 10 charges including fraud, false statements and selling adulterated medical devices.
U.S. Attorney George Holding said Tuesday that authorities believe Patel has fled to his native India and have turned to Interpol for cross-border aid in catching up to him.
“Our office is committed to pursuing him and bringing him here to account for his actions,” Holding said.
Court documents portray a disturbing recklessness that allowed syringes to ship before they were checked for contamination. Reports detailing the testing were backdated to appear they passed procedure before shipping, and some test results were manipulated or fabricated to deceive inspectors from the U.S. Food and Drug Administration, prosecutors said.
Patel’s company sold nearly $7 million worth of heparin, a blood thinner, and saline syringes in 2006-07. The plant in Angier, about 20 miles south of Raleigh, cut corners so it could maximize profit, including shipping products quickly without checking on safety, according to court documents.
The syringes were recalled in December 2007 after an outbreak of illnesses. Health inspectors identified bacterial infections in Colorado, Texas, Illinois and Florida and traced the contamination to AM2PAT.
It’s a similar disregard for consumer health that congressional leaders portrayed in the salmonella outbreak traced to products from a Georgia peanut plant that sickened 600 people and may have contributed to nine deaths. Company e-mails released by a U.S. House committee showed Peanut Corp. of America owner Stewart Parnell ordered products tainted with the bacteria to be shipped because he was worried about lost sales. Parnell has not been charged, but federal officials are investigating.
Ned Feder, a staff scientist at the Washington-based nonprofit Project On Government Oversight, said the FDA must rely to some extent on the honesty of plants, but that the agency also needs to verify the paperwork companies produce. The FDA doesn’t inspect often enough, largely because it is short on staff, he said.
“You hardly turn around and the FDA is breaking news,” Feder said. “If it isn’t peanuts in Georgia, it’s syringes in North Carolina. They’re completely different (cases), but they can both be traced back to the fact that the FDA doesn’t have the manpower to do the policing it needs to do.”
FDA spokeswoman Siobhan DeLancey declined to immediately discuss the syringe case. She acknowledged that it’s impossible for inspectors to be in every plant at once but said the FDA performs regular checks.
Several people have sued since the fallout of the tainted syringe case, and prosecutors still aren’t sure exactly how many were affected by it. Heparin and saline are used to flush intravenous lines during cancer treatments, kidney dialysis and other procedures.
“One of the worst things about this case is that the people who were taking saline and heparin, they’re usually sick already or have some debilitative illness and need these medicines to try to get well,” Holding said. “Sometimes it’s hard to determine whether they were killed from the tainted heparin or whether it was the original illness. We’re not able to say any more than five.”
AM2PAT was incorporated in Chicago, where Patel lived, but had its only plant in North Carolina.
Patel said about a year ago when federal officials were investigating the sicknesses that his company voluntarily recalled the syringes in question and there was “nothing out there anymore.” Prosecutors do not know if Patel still has an attorney. He faces up to 95 years in prison, if convicted.
Plant manager Aniruddha Patel, 43, of Carpentersville, Ill., and quality control director Ravindra Kumar Sharma, 54, of Richmond, Va., each were sentenced Monday in U.S. District Court in Raleigh to 4½ years in prison for fraud and allowing tainted drugs into the marketplace.
___
Associated Press Writer Estes Thompson contributed to this report.
Copyright 2009 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
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Prosecutors: NC company shipped tainted syringes
By MIKE BAKER
Associated Press Writer
RALEIGH, N.C. (AP) — A North Carolina company is accused of bypassing sterilization tests for medical syringes in a cost-cutting move prosecutors say sickened hundreds of patients and led to five deaths.
U.S. Attorney George Holding said Tuesday that federal authorities have launched an international search for the executive charged with rushing shipments of bacteria contaminated syringes from an AM2PAT Inc. plant. Two former plant workers who provided prosecutors details about the plant’s operations have pleaded guilty for their roles in shipping tainted syringes.
The syringes contained Heparin, a blood thinner, and saline, and were recalled in December 2007 after an outbreak of illnesses. Health inspectors identified bacterial infections in Colorado, Texas, Illinois and Florida.
Heparin and saline are used to flush intravenous lines during cancer treatments, kidney dialysis and other procedures.
The U.S. attorney said investigators believe AM2PAT CEO Dushyant Patel has fled to his native India. Patel was indicted last week on 10 charges including fraud, false statements and selling adulterated medical devices.
“Our office is committed to pursuing him and bringing him here to account for his actions,” Holding said. “We’re putting all resources available to bringing him back here.”
Holder did not know who Patel’s attorney was.
AM2PAT is based in Chicago and had a subsidiary in North Carolina.
Patel’s company sold nearly $7 million worth of heparin and saline syringes in 2006-07. Prosecutors said the facility in Angier, about 20 miles south of Raleigh, cut corners and failed to follow rules for checking sterility. They also said manufacturing dates were falsified to make it appear that safeguards were followed.
The scheme led to bacterial infections in 200 to 300 patients around the country, some of them resulting in spinal meningitis and permanent brain damages, prosecutors said. Even more people may have become infected.
“One of the worst things about this case is that the people who were taking saline and heparin, they’re usually sick already or have some debilitative illness and need these medicines to try to get well,” Holding said. “Sometimes its hard to determine whether they were killed from the tainted heparin or whether it was the original illness. We’re not able to say any more than five.”
Patel said about a year ago when federal officials were investigating the outbreak that company voluntarily recalled the implicated syringes and there was “nothing out there anymore.”
Plant manager Aniruddha Patel, 43, of Carpentersville, Ill., and quality control director Ravindra Kumar Sharma, 54, of Richmond, Va., each were sentenced Monday in U.S. District Court in Raleigh to 4½ years in prison for fraud and allowing tainted drugs into the marketplace.
Copyright 2009 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
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Baxter Didn’t Know About Absence of Inspection
Baxter International Inc. CEO Robert Parkinson admitted this week that a combination of factors resulted in this plant not being inspected by the FDA until this week. Baxter stopped manufacturing the product last week. Among those factors are that Baxter didn’t import the active ingredient itself, but thru a Wisconsin based company, Scientific Protein Labroratories, based in Waunakee, WI. The active ingredient was actually produced in Changzhou, China. The plant which was co-owned between Scientific Protein and its Chinese Joint Venture partner, never was inspected because some confusion over the name.
This issue of bureaucratic malfeasance, and failure to properly trace all of the active ingredients in a product sold by an American company that is manufactured outside the control of American laws, labor rules and health regulations, is an endemic to the current mood of the huge growth in component import of what appear to be American made products.
Unless the standards for production of these components (such as the active ingredient in heparin or the paint on child’s toys) changes, the calls for American only products will grow louder and the shrill cry of American protectionism against imports may become a catalyst to the growing interdependence of world economy.
Is the lead paint and the heparin debacle, just a tip of the iceberg here? Is this the result of 7 years of handsoff regulation from the Bush administration? Can our products ever be reasonably safe again?
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
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FDA Probes 4 Heparin Deaths from Baxter
Baxter Healthcare has temporarily stopped making multiple-dose vials of the injectable blood-thinning drug heparin because of recent reports of four deaths and other serious reactions. However, the FDA is not requiring that all use of Heparin from Baxter stop.
The FDA actions only apply to Baxter’s multiple-dose vials of heparin.
Serious reactions to Baxter’s heparin BOLUS doses have included difficulty breathing, nausea, vomiting, excessive sweating, and rapidly falling blood pressure that can lead to life-threatening shock.
There are usually 2 ways that a drug may be administered intravenously. Bolus or drip. A bolus dose is when the doctor injects the drug all at one shot into the vein, usually within seconds or minutes. Drip is when the drug is connected to a tubing and allowed to flow slowly into the vein. Different drugs have different pharmacokinetics and dynamics such that they may behave differently given in these 2 different ways. For example, 10 mmols of potassium chloride (KCL) given as an intravenous bolus dose will be fatal, causing heart arrhythmias, whereas 10 mmols of KCL given in a drip over 2 hours is commonly used to correct low potassium.
“It’s not clear if the drug caused any of the four deaths,” notes John Jenkins, MD, director of the FDA’s Office of New Drugs.
Since late December, the FDA and Baxter have received “approximately 350 adverse event reports, and approximately 40% of those reports have been characterized as serious,” Jenkins said at a news conference.
“Health care providers should be aware that serious adverse events of the same type have been reported in a few cases where single-dose vials of Baxter heparin were combined in order to give a large bolus dose to a patient,” Jenkins says. “It appears that the adverse reactions that we are seeing are related to bolus dosing, and therefore even using single-dose vials to generate the dose necessary to get the bolus could be of concern.”
FDA’s Advice
The FDA offers this advice about Baxter’s heparin to health care providers:
* Give the drug as an intravenous infusion, not as a bolus dose, whenever possible.
* Use the lowest dose necessary at the slowest infusion rate acceptable.
* Carefully monitor patients for adverse events and have staff and equipment available to intervene, if necessary.
* Doctors should weigh the risks and benefits of pretreatment with corticosteroids or antihistamines to relieve symptoms of allergic reactions.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
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Heparin Deaths Mount
The Chicago based Nolan Law Group is uniquely qualified to pursue any claim for wrongful death or injury as a result of these tainted drugs. Not only is the Nolan Law Group based in Illinois, it has for years taken the leadership role in multi-plaintiff cases involving injury and death. We are not out to pursue thousands of small cases, but are here to represent those with serious claims.
To contact us, call 800-992-9447.
The claim against Baxter came to attention with this notice from the FDA on January 17, 2008:
Baxter’s Multiple-dose Vial Heparin Linked to Severe Allergic Reactions_FDA advises health care practitioners to switch suppliers and limit use of drug until problem identified
The U.S. Food and Drug Administration announced today that Baxter Healthcare Corporation has temporarily stopped manufacturing multiple-dose vials of the injectable blood-thinning drug heparin due to reports of serious allergic reactions and hypotension (low blood pressure) in patients who receive high “bolus” doses of the drug.
Serious reactions to the drug have included difficulty breathing, nausea, vomiting, excessive sweating, and rapidly falling blood pressure that can lead to life-threatening shock. Four people have died after receiving heparin, although the relationship to the drug is unclear.
Heparin sodium is derived from pig intestines and has been marketed in the United States since the 1930s. Millions of patients benefit from the intravenous administration of this drug every year to avoid potentially life-threatening blood clots in the veins, arteries, and lungs.
“FDA concurs with Baxter’s decision to halt manufacture of heparin sodium in multiple-dose vials,” said Janet Woodcock, M.D., FDA’s deputy commissioner for scientific and medical programs, chief medical officer, and acting director of its Center for Drug Evaluation and Research. “FDA is vigorously investigating to determine the root cause of these serious reactions associated with the use of heparin made by Baxter. In the meantime, patients and health care professionals who cannot obtain alternative sources of heparin should use caution in administering any Baxter multiple-dose vials that remain.”
Heparin is commonly used before certain types of surgery, including coronary artery bypass graft surgery, and in kidney patients before they undergo dialysis. In some situations, heparin treatment is initiated using a high bolus dose given directly into the bloodstream (intravenously) over a short period of time, usually less than one hour. The reported adverse events occurred in patients who were given heparin in this form of administration. There are many other uses of heparin involving lower doses or administration over a longer period of time; adverse events have not been seen with those uses.
About 350 adverse events associated with the Baxter product have been reported since the end of last year compared to less than 100 reports in 2007. Most of the events have taken place at hemodialysis centers, almost exclusively involving patients receiving a bolus dose – which is a high dose administered over a short time. While most of the reports involve multiple-dose vials, several cases include patients who received a bolus dose after their health care professional combined heparin from single-dose vials.
The Missouri Department of Health and Senior Services first notified the Centers for Disease Control and Prevention (CDC) in January of several severe allergic-type reactions to heparin that occurred at a single pediatric hospital beginning in November. The CDC in turn alerted FDA and Baxter, prompting the company’s voluntary recall of nine lots of heparin on Jan. 17.
Since then, FDA has learned of adverse events that extend beyond the recalled lots and involve patients receiving heparin for other purposes besides hemodialysis. Recent cases have included patients undergoing cardiac surgery and a specialized blood cell treatment known as photopheresis.
Over one million multiple-dose vials of heparin are sold per month in the United States; half of the vials are manufactured by Baxter of Deerfield, Ill. FDA is currently investigating whether similar events have been seen with other heparin manufacturers.
Physicians, dialysis center staff and health care providers are advised to use an alternate source of heparin or another blood-thinning drug when possible. When only Baxter product is available:
. Administer the heparin as an infusion (not a bolus) whenever possible.
. Use the lowest dose necessary at the slowest infusion rate acceptable to obtain the desired clinical effect.
. Closely monitor the patient for adverse events, particularly hypotension and signs and symptoms of hypersensitivity and ensure that resuscitation equipment is available.
. Consider pretreatment with corticosteroids (cortisone type medicines) or antihistamines (drugs that relieve the symptoms of allergic reactions) although it is not known if such pretreatment is effective.
Baxter halted its manufacture of Heparin in mid-February, but as of February 19, 2008, had not identified a particular cause for the problems, according to the Chicago Tribune on such date:
http://www.chicagotribune.com/business/chi-biz-app-pharmaceuticals-heparin-feb19,0,6556322.story
For information on the recall, click here:
http://www.fda.gov/bbs/topics/NEWS/2008/NEW01797.html
To contact us, call 800-992-9447.
Maitto:g@gordonjohnson.com
©Gordon S. Johnson, Jr. 2008
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Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
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