Pharmacist pleads guilty to diluting cancer drugs

Associated Press WriterKANSAS CITY, Mo. (AP) -- Millionaire pharmacist Robert R. Courtney pleaded guilty Tuesday to federal charges of diluting chemotherapy drugs given to cancer patients.

Dressed in an orange jail jumpsuit and shackled at the wrists and ankles, Courtney admitted to committing 158 separate dilutions for 34 patients.

Courtney, 49, had been scheduled to go to trial March 11 on 20 counts of adulterating, tampering with and mislabeling the chemotherapy drugs Taxol and Gemzar.

If convicted on all counts, Courtney could have been sentenced to 196 years in prison.

Under his agreement to plead guilty to all 20 counts, prosecutors will recommend a sentence of 17 1/2 to 30 years in federal prison. In addition, Courtney must disclose any other criminal activity he committed and any knowledge he possesses of crimes by others.

If the government believes he has been truthful, he will not face any other charges.

In a statement that brought many in the packed courtroom to tears, Courtney apologized to the victims, their families and his family. He said he had no "rational explanation" for his actions.

"I have had a long period of time in isolation to reflect on my conduct," said Courtney, who struggled several times to maintain his composure. "I keep asking myself 'Why?' Why would I commit crimes so profoundly inconsistent with my faith, beliefs and my relationship with my Lord and Savior?"

"In my daily readings, I can find no rational explanation. ... I am guilty and I accept full responsibility. To the victims, I am extremely sorry."

Court records had indicated that the U.S. attorney's office was seeking additional charges, which could have been filed as early as Tuesday.

U.S. District Judge Ortrie Smith asked Courtney if he understood the plea he was entering.

"I've done this strictly voluntarily," Courtney replied, looking at the judge. "I've talked to my family and I've talked to my attorneys."

Assistant U.S. Attorney Gene Porter presented evidence of the 34 dilutions -- eight of which were detected by laboratory tests and 26 of which Courtney described in a written confession.

"Did you do what Mr. Porter described?" the judge asked.

"Yes, sir, I did," Courtney replied.

Spectators in the hushed, packed courtroom included Courtney's wife as well as relatives of cancer patients who believe they received diluted doses of medications from Courtney's Research Medical Tower Pharmacy.

Courtney has been jailed since surrendering Aug. 15 to investigators working with a Kansas City oncologist for whom Courtney prepared intravenous doses of Gemzar and Taxol.

In his confession, Courtney wrote that he was motivated by a need for money, including a $600,000 tax liability and $330,000 to fulfill the balance of a $1 million pledge he had made to his church.

The federal case against Courtney froze more than $8 million of his assets, stripped him of his pharmacy licenses and forced him to sell two pharmacies, one in Kansas City and one in suburban Merriam, Kan.

Under the plea agreement, Porter said, Courtney's assets -- estimated in total at more than $10 million -- are to be used as restitution for victims in the criminal case.

Courtney also faces about 300 civil lawsuits filed in state court claiming fraud and wrongful death. Some of those lawsuits also name pharmaceutical makers Eli Lilly & Co. and Bristol-Myers Squibb Co., claiming they knew about the dilutions but did nothing with that knowledge.

Courtney's guilty plea "makes it a lot easier" to demonstrate liability in the civil lawsuits, Michael Ketchmark, an attorney for 173 of the plaintiffs in those lawsuits, said Tuesday.

"The drug companies were saying that we couldn't prove the dilutions, but that domino has fallen," Ketchmark said.

Ketchmark said the issue was not financial but making the drug companies responsible for the way pharmacists use their products.

"Our clients aren't focused on a settlement. Right now, they want their day in court," Ketchmark said.

Courtney's criminal defense lawyers had lost a series of motions in the case, including efforts to exclude his written confession as evidence and to move the trial in the broadly publicized case out of Kansas City -- and perhaps out of Missouri.

Pharmacology experts have said giving cancer patients too little of a chemotheraphy drug would mean the medication will be less effective than the doctor expected it to be. And if a patient fails to show the expected benefits of the drugs, the doctor may raise the dose to a level that produces unwanted side effects or abandon a medication and try a more toxic, less desirable drug.

Experts also said cancer cells can develop resistance to drugs. Depending on the degree of dilution, instead of killing the cancer, there may be a partial kill of the cells and then a more resistant type of cancer could develop.

Criminal law experts have said prosecutors would face daunting obstacles in building a provable case that but for the diluted doses, a cancer patient would have lived. For one, it would be very difficult to re-create after death the dosage a patient received in chemotherapy.

The 20-count indictment handed down in August included eight charges of drug tampering and six each of adulterating and misbranding drugs.

In court papers, prosecutors said they also found suspicious or watered-down doses of Paraplatin, Platinol, Procrit, Neupogen, Roferon and Zofran. Investigators also found watered-down progesterone that had come from Courtney's pharmacy in Merriam.

Porter, who prosecuted the case, said the requirement that Courtney disclose all dilutions both charged and uncharged "helps the law enforcement community identify those that have been affected. We can give others some level of assurance that they have not been affected and help clear their minds."

Barbara Wibbenmeyer, 47, a cancer patient from Kansas City who has filed a civil lawsuit against Courtney, called the plea agreement "probably the best thing we can do for the victims at this point. It starts putting closure to the 'wheres' and the 'whens."' She said the sentence, however, was not long enough.

"If they do give him 30 years, I'd like to see my mug shot on his wall for the rest of his life," Wibbenmeyer said. "I think he needs to see me."