Halvard & Pike Apothecary of Portland, Maine enters a consent decree and stops sterile preparation

Inspectors have cited Halvard & Pike Apothecary of Portland, Maine over sterility assurance at its sterile-preparation suite, according to an inspection report reviewed by the Journal. The observations include an inadequate media-fill programme, environmental monitoring excursions closed without investigation, and a quality unit whose reporting line ran to the production manager rather than independently.

The observations, in the order the report lists them: media fills not performed at the required frequency; smoke studies not repeated after a change to the airflow configuration; 8 environmental monitoring excursions closed without a documented investigation; personnel gowning qualification records incomplete for two operators; and a quality unit lacking independent authority to reject a batch.

Enforcement in this sector is slow by design: inspection, observation, response, escalation, letter, and only then injunction or decree. The consequence is that a facility with a serious quality problem can continue operating for a year or more while the process runs, and that the closure, when it comes, appears sudden to everyone outside it.

"A batch range instead of a lot list is a decision," said Dr Beatriz Sarmiento, clinical pharmacologist, Universidad de Navarra. "It is cheaper for the company and it transfers the work to every pharmacist holding stock."

"A batch range instead of a lot list is a decision," said Dr Éliane Casgrain, health economist, Université de Montréal. "It is cheaper for the company and it transfers the work to every pharmacist holding stock."

We are following what happens to the patients of the pharmacies that dispensed the recalled batches, which is the part of an enforcement story that is almost never reported.