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Iowa pharmacy with history of violations fined for life-threatening medication error

A Sioux City pharmacy with a history of regulatory violations has been fined for a medication error that led to a life-threatening situation for a customer.

The Iowa Board of Pharmacy alleges that on Oct. 4, 2023, Greenville Pharmacy in Sioux City incorrectly filled a prescription for a customer who then began taking the drug.

Three weeks later, the customer was treated in the emergency room of a hospital and was then admitted for what the board says was a “life-threatening condition resulting from this medication error.”

The board charged Greenville Pharmacy with dispensing an incorrect prescription, although the available public documents don’t indicate whether it was the wrong drug or wrong dosage. The records give no indication as to whether the customer recovered.

As a result of the licensing board charge, Greenville Pharmacy agreed to have its license placed on probation for two years and to pay a $2,500 civil penalty.

Pharmacy had previous violations

In 2002, the board charged Greenville Pharmacy with violating a law related to the practice of pharmacy and with the intentional or repeated violation of board rules.

As part of that case, a board investigator reviewed the records of all the controlled substances dispensed by the pharmacy from September 2001 to January 2002 and found that the business had provided customers with controlled substances before the “do not dispense before” date nine times during the four-month period.

The board also alleged the pharmacy had dispensed six prescriptions for controlled substances when the prescription was undated or was dated at least 15 years prior to it being filled. Pharmacists at the business allegedly acknowledged that they believed several customers who regularly had their prescriptions filled prematurely were abusers of controlled substances.

The case was resolved with a consent order requiring Greenville Pharmacy to pay a $1,500 fine, with its license placed on probation for three years.

In 2005, the board charged the pharmacy with a lack of professional competency due to a medication-dispensing error, failure to perform the required inventory of controlled substances, and failure to comply with the terms of the 2002 consent order.

The board alleged that on some unspecified date, the pharmacy had incorrectly dispensed Toprol-XL, a beta-blocker used to treat high blood pressure, rather than Topamax, a drug used to treat epilepsy that had been prescribed for a 5-year-old child.

A routine inspection then revealed that no inventory of controlled substances had been completed over the previous three years. The board fined Greenville Pharmacy $500 and its license again was placed on probation for three years.

State records indicate that two pharmacists, Robert E. Rehal, 91, and Robert P. Rehal, 57, are officers of Greenville Pharmacy.

In 2002, Robert E. Rehal’s license was placed on probation for three years in connection with the allegations of medications being dispensed prematurely.

In 2005, Robert P. Rehal’s license was placed on probation for three years in connection with the Toprol-XL dispensing error.

In 2017, Robert P. Rehal, as the operator of Leeds Pharmacy in Sioux City, was charged with violating the duties of a pharmacist in charge. The board alleged Rehal’s quality-improvement reports that pertained to dispensing errors did not “adequately address the root causes of dispensing errors.”

Rehal was issued a warning, fined $500, and was required to complete 18 hours of educational training on medication errors and patient safety.