Prescription For Profit

Meet The Whistleblower Who Exposed A Hospital's Dangerous, And Costly, Pill Swapping

(CBS)  William LaCorte is no ordinary doctor.

"It's amazing that any pharmaceutical reps call on me at all," he said.

He's been fighting a one-man battle against a widespread medical practice. It puts profit ahead of health and costs you hundreds of millions of dollars, CBS News correspondent Sharyl Attkisson reports.

"I may be just a big pain in the ass," he said.

It started when he caught Memorial Hospital in New Orleans doing something very odd.

Every time he prescribed Zantac, the hospital changed it to Pepcid. Both are acid blockers than can prevent dangerous internal bleeding.

"I said, 'why is it I'm ordering one drug and a totally different drug is being given?'" LaCorte said. "And I was told 'therapeutic interchange.'"

Therapeutic interchange meant the hospital was switching virtually all antacid prescriptions to Pepcid. And it wasn't a meaningless change.

While LaCorte says Pepcid is a good drug, it was given in doses that were too strong for some patients, making them very sick. One even went into a coma.

When he tried to find out why so many were given Pepcid, he discovered Memorial Hospital had made what's called a "market share" deal with Merck, the maker of the drug. As long as 80 percent of patients were on Pepcid, Merck gave the hospital a deep discount.

The hospital's task was to get almost all of the patients who needed that type of drug on the Merck brand drug, according to LaCorte.

LaCorte complained to everyone he could think of … without result.

Finally, he got the feds involved - by proving taxpayers were being defrauded. It turns out the Pepcid cost twice as much as Zantac, and since many patients were on Medicaid or Medicare, taxpayers covered the extra cost.

The fight took 12 long years, but Merck recently agreed to pay back taxpayers $650 million for deals to get hospitals nationwide to favor not only Pepcid, but also Merck drugs Zocor and Vioxx.

Under U.S. law for whistleblowers, LaCorte will get a sizable payment from the recovered money.

"This is a widespread practice with multiple medications," he said. "This is business-as-usual for the hospitals and drug companies in the United States of America today."

LaCorte says taking them on is tougher than fighting City Hall.

But he's just the doctor with the bedside manner to do it.

[cwashbu]

I have worked in "Mission based" health care for 35 years. As a pharmacy director, controlling our formulary cost is one of the most important things we do to ensure we can provide medical care to every one that enters our door. I am a little confused by the "PROFIT" comments about TI. In California, most government sponsored insurance pays a DRG or a Per Diem rate for a patient''s hospital visit. Pharmacy is no longer considered a revenu producer but a cost center. We spend considerable effort counter detailing the "latest & greatest" medication that hits the market. The drug inndustry has stopped much of the "free stuff" for physician''s and pharmacists but I imagine it still exists. I suggest to the critics of TI, to call their local, "mission based" hospital pharmacy director and schedule a meeting to discuss. The discussion might go differently at a hospital the is "profit" oriented.

[kerrjac1]

This isn''t a blanket criticism on TI, but just as it concerns medicare and public spending. You''ll notice it''s part of Atkinson''s follow the money series, which is one of the my favorite CBS segments. It''s not about medical malpractice, though there are implications for that.

If you follow the money, it''s clear that the hospital''s saving money because they''re getting a kick-back from Merck. And Merck is making money because they''re selling more goods. The average medicare patient is unaffected, because they wouldn''t be paying for their drugs anyway. The money that Merck, and consequently the hosptial, are making comes from the taxpayer.

I''m not on medicare, I pay for my own drugs through insurance or directly. If I were particularly vigilant, I might notice that I could save more money in the long term by getting the prescription from a non-hosptial pharmacy, just as I might buy clothes from a store that had a sale. That''s how capitalism works.

However, a medicare patient has no incentive to save money, and in all likelihood may be too old to seek out a cheaper price.

Neither the hosptial, nor Merck, nor patients have a direct incentive to blow the whistle, even though taxpayers are losing out. That''s why Lacorte did an admirable deed, and deserves a financial reward.

[kerrjac1]

No one is hurt by this? What about us taxpayers who payed twice as much for people to be on pepcid?

[rphny]

It''s unfortunate that this type of hype is given to a routine practice at every hospital across the country. This practice of substituting one drug for other drugs in the same therapuetic class actually saves the patients, the hospital, and the insurance companies (state, federal or private) money while providing the same level of care to the patient. What the good doctor fails to tell us is how much money was saved on the other Merck medications given at the hospital during that period of time. It''s also very easy to blame Pepcid for causing a coma, yet what other dugs was the patient on, or what other conditions did the patient have that may have led to a coma? Did he rule out all of those other causes. The other thing he doesn''t mention is that these substitutions don''t go on without anyone''s knowledge. They are always approved by the pharmacy and the medical staff. Let''s remember that the settlement was against Merck for their dealings and not against the hospital for its practices. And for those who think they should get what ever they want when they go into a hospital, they should remember that the care you receive is based on the policies and procedures of the hospital which you provider must agree to follow in order to have the ability to care for patients there. Just the same as Lacorte did. He seems to have had a vendetta against a few people. I hope every who takes Mercks products now is happy, wait until the cost goes up to cover the cost of the settlements :).

[barbjc1]

I don''t know about prescription drug switching, but I do know about hospitals padding bills with services that WERE NOT USED.

[cbarnes99]

As a Pharmacist at a small non-profit community hospital, we rely on the practice of therapeutic interchange (TI) to allow us to safely provide our patients with medications. It is true that TI usually is designed to same money by allowing the pharmacy to stock a limited number of medications, but what has been lost here is the safety advantage of this practice. Despite what was reported in this story, TI has safety advantages! Hospitals are required by The Joint Commission to have a formulary. The formulary process at a hospital involves providing Prescribers, Nurses, and Pharmacists with drug information, including patient counseling information for each medication on the formulary. It would be nearly impossible for a hospital Nurse to stay aware of every medication on the market. The hospital staff relies on the P&T committee to make sure that if a medication is available in a hospital, then nurses know how to use the medication and what to look for as far as side effects. Stocking all medications would be detrimental to patient safety as well as being financially irresponsible to the hospital. Even the most state of the art hospital does not stock every medication on the market %u2013 it would be unwise and unsafe! I would hope that the producers of CBS evening news would report the whole story, not just sensational stories that promote distrust and fear.

[grammawhamma]

Posters: I am a nurse. Please go back and read the posts of whunt31045 and ldharlow. They know what they are talking about and what they say is correct. No one is harmed by this practice and it lowers a patient''s hospital bill.

[dan_shields-2009]

Business as Usual...Outrageous I''m glad he ratted them out and The Justice Department sued them!

[jarreau12]

Dr. Lacorte is one of the most unethical, unprofessional physicians in all of New Orleans. He has become a millionare off of the taxpayers $$$ due to his prolonging the life of soo many terminal patients. He gives families false hope to make more money. I can''t believe he won this law suit!!!! There''s no way that pepcid puts anyone into a coma... Seriously...... I bet if you look into this patients'' status, they were probably terminal with multiple debilitating problems.... This report disgusts me along with many health care professionals who know the real Lacorte.
I''ve lost respect for Katie and the CBS news for this horrible story........

[jarreau12]

wow!

[rowdytexan2]

Posted by whunt31045 at 08:22 AM : Mar 08, 2008

Frankly, I do not want some hospital board, or any other person deciding my health care. I pay a doctor for his services, and I expect to get the treatment that he prescribes for me.

Corporate decisions should not enter into the health care of patients!

[erasmus6]

Wow. Unbelievable.


"The world is insane!!" posted by ssm9451

Ahh, I don''t know about the world, but the U.S. certaintly is!

[missingamerica]

lolll..is it me, or do you get the impression some of the posters are lobbyists for Big Pharma and/or the Factory Hospitals, too?

[eviemammo]

I find the report of something that we have seen before nothing but fluff! About a week or two ago the same report was on the news about a hopital in Houston, Tx. Not discounting the what the piece was trying to convey, but there was nothing really news worthy. The reporter didn''t indicate that Memorial Medical was owned by Tenent Health Care and another medical corporation during the 12 years indicated in the report. Also, there was a failure of the report to state how much money the "good" doctor is pocketing. Where does this Dr now practice? Does he see the same thing at the facility he has hospital admits his patients? This report has so many holes in it it looks like Swiss Cheese.
I guess that picking on a hospital in New Orleans is enough to catch the attention of you audience, but telling the hole truth about the piece will keep them.

[hypnotoad72]

drinuk - so you think there''s a problem; what are YOU going to do about it?

[whunt31045]

This is just one side of the story. Hospitals use therapeutic interchange (TI) for many reasons; costs, safety, storage limitations, etc. These are approved by a panel of doctors and hospital staff that are considered drug experts, usually with very strict limitations.

Often, TI is an alternative to the massive marketing of drugs to doctors and that costs taxpayers many, many more millions than TI. TI more often than not substitutes a generic drug for a brand name drug.

TI is a way for hospitals to cut costs, allowing any doctor to prescibe any medication would increase the already astronomic cost of hospital care and not improve the quality of care.

[drinuk]

This story is yet another in the annals of the evil and corrupt medical profession. Big Pharma, the FDA, Congress and your friendly doctor are complicit in manslaughter and genocide.

What as it come to when we lie in bed sick and helpless relying upon thieving maniacs who have sold our life and well being for ten bucks.

The threat of Osama Bin Laden pales into insignificance as compared to the these evil crooks.
This cartel killed far more people last year than the Mad Mullar did. The people must act before it gets worse.

[gixmo1020]

I suppose the drug companies will tell us they need this money for R&D to develop more life saving drugs when, in fact, the largest share of their profits go to marketing.

[ontheleft]

"I may be just a big pain in the ***," he said.

Sounds a lot like me. Geesh.

[sara27155]

Over the past 4 years I''ve been in three different hospitals here in Michigan who do the same thing. When I am admitted I take all my medications in with me. If I am able (and if not my family) asks the nurses upon admission what the medications are they plan on giving me. On the admission papers we write NO MEDICATION CHANGES as well as during the nurses admission evaluation. All three of them tried to give me Pepcid. When I tell them I take Nexium they tell me they don''t carry it, so I make them use my medication from home. The last admission in November there were 3 different medications they tried to do this.