Farina v. Department of Health

972 P.2d 531, 94 Wash. App. 441
CourtCourt of Appeals of Washington
DecidedMarch 2, 1999
DocketNo. 16879-4-III
StatusPublished
Cited by14 cases

This text of 972 P.2d 531 (Farina v. Department of Health) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Farina v. Department of Health, 972 P.2d 531, 94 Wash. App. 441 (Wash. Ct. App. 1999).

Opinion

Sweeney, J.

— This appeal requires us to harmonize inconsistent parallel regulatory schemes governing home health care and pharmacy respectively.

RCW 70.126 is the enabling act which authorizes the Washington State Department of Health (Department) to establish home health care agencies. Pursuant to that stat[446]*446ute, the Department promulgated WAC 246-327. RCW 18.64 is the enabling act which created the Washington State Board of Pharmacy (Board) to regulate the practice of pharmacy, pursuant to which the Board promulgated licensing regulations in WAC 246-869.

Joseph Farina is a licensed pharmacist. He owns two pharmacies and a home health care franchise. The Board applied pharmacy regulations to the operation of his home health care facility. By doing so, it concluded that Mr. Farina violated a number of pharmacy regulations. It therefore suspended his license to practice pharmacy.

The question presented is whether, under the home health care and pharmacy regulations operative at the time, the Board could suspend Mr. Farina’s pharmacy license for dispensing drugs at his separately licensed home health care agency, even though the home health care agency was operating in compliance with the home health care regulations. We conclude it could not. We also agree with the superior court that any violations were technical and inadvertent. We therefore reverse the sanctions.

FACTS

Mr. Farina has been a licensed pharmacist since 1975. He owns two licensed pharmacies in Yakima: Consulting And Pharmaceutical Services, Inc. (C.A.ES.) and Pharmaco d/b/a Option Care.

Option Care: Option Care is a franchised home health care agency, licensed under RCW 70.127. Home health care agencies provide in-home services to patients who would otherwise be hospitalized long-term. Among other services, the agency provides total parenteral nutrition (TPN)1 supplemented with intravenous (IV) prescription medications in the home. Generally, pain management is accomplished by means of self-administered IV narcotics. These services are prescribed by a physician and carried [447]*447out by registered nurses. The nurses train patients and family members to administer the IV in the home.

In 1987, Mr. Farina expanded his Yakima Option Care franchise with a branch office in Wenatchee. The Wenatchee branch operated under Pharmaco’s home health care license. When a physician referred a patient to Option Care Wenatchee, the standard procedure was to fax the patient’s records and prescriptions to Option Care Yakima. There, licensed pharmacists prepared the medications and TPN solutions and sent them by courier to Wenatchee to be administered by a nurse.

Occasionally drugs were needed immediately, such as for a new patient referral on short notice or before a holiday, or to accommodate a sudden increase in the dosage. At first, Option Care Wenatchee obtained these emergency medications at the local hospital pharmacy. The branch agency was, however, very successful and expanded rapidly. So the local pharmacies stopped selling it drugs, citing professional competition considerations.

To meet these emergencies, then, some drugs were kept on-site, to be mixed and administered by the nurses. The nurses were trained by the Yakima pharmacists to prepare narcotics and antibiotics, as well as TPNs. These were stored in a file cabinet called the “emergency box.” Before they actually mixed anything, nurses telephoned the Yakima pharmacy, and a pharmacist then talked them through the procedure step by step. Some mixing of drugs was done in patients’ homes, following a pharmacist’s prior calculations and instructions.

The quantity of stored drugs increased with the volume of patients. The nurses believed they were acting within the scope of accepted nursing practice in mixing prescription drugs and TPNs when necessary. In 1990, the Joint Commission on Accreditation for Home Care Organizations, a national accreditation company, inspected the Wenatchee site and approved the operation.

The business then moved to its present location. The new facility included a room for storing and preparing [448]*448emergency medications and TPNs. It had a laminar airflow hood2 for sterile work. The room was not accessible to the public and was locked. The staff called this room the “pharmacy,” and someone made an 8V2-by-ll-inch “Pharmacy” sign that was posted inside the room.

Yakima Option Care pharmacists monitored the Wenatchee operation, performed on-site visits, reviewed records, and occasionally mixed TPNs. Because of the increasing volume of work, the nurses asked Mr. Farina to hire a full-time pharmacist. But everyone understood from Mr. Farina that Wenatchee was an extension of the Yakima pharmacy and operated under its license.

When asked in 1991 about Option Care Wenatchee, Mr. Farina told a Board employee that it was a nursing office which stored Heparin and other legend drugs needed to maintain IV lines. In January 1993, following a preannounced inspection, the Board declared that the Wenatchee facility was an illegal pharmacy and removed the narcotics. All remaining drugs were immediately returned to Yakima.

C.A.P.S.: The Board had long been aware of C.A.ES.’s professional practice. C.A.PS. had successfully undergone annual Board inspections since 1989. C.A.RS. supplied medications to institutional customers including nursing homes, medi-centers and Planned Parenthood. C.A.PS. pharmacists repackaged drugs from manufacturers’ containers into smaller, custom-labeled containers for distribution. C.A.ES. also maintained required records for these customers. The Yakima Health District followed the same system.

During a 1992 phone call, an inspector told Mr. Farina that if C.A.ES. were still delivering to the medi-center, he “may want to think about [getting] the manufacturer’s license.” Mr. Farina questioned the necessity for this, but acceded to the suggestion and applied for the manufacturer’s license. Before the license was issued, the Board [449]*449inspected C.A.ES. and cited it for manufacturing pharmaceuticals without a license.

Administrative action: The Board charged Mr. Farina with unprofessional conduct. After an administrative hearing, the Board entered findings and conclusions to the effect that Mr. Farina had both knowingly permitted the practice of pharmacy without the presence of a pharmacist and operated an unlawful pharmacy without a license or controlled substance registration at Wenatchee, and that C.A.ES. had manufactured drugs without a license or controlled substance registration in Yakima. The Board concluded that this conduct constituted moral turpitude, dishonesty and corruption relating to Mr. Farina’s fitness to practice pharmacy.

The Board suspended the pharmacy licenses of C.A.ES. and Option Care for two years, but granted an immediate conditional stay of the suspension. Mr. Farina’s individual pharmacist’s license was suspended for five years with permission to apply for a stay after six months if specified conditions were satisfied.

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972 P.2d 531, 94 Wash. App. 441, Counsel Stack Legal Research, https://law.counselstack.com/opinion/farina-v-department-of-health-washctapp-1999.