Toiyabe pharmacy staff: CEO shielding ‘illegal activity’ with allegations

By: 
Terrance Vestal
Managing Editor

In a response to a litany of accusations laid out earlier this week by the Toiyabe Indian Health Project administration, Toiyabe pharmacy staff, some of them former, have responded with a letter to the community outlining a series of allegations against the administration, including conducting a biased investigation, skirting federal patient protection laws and mismanaging the clinic’s finances.
Toiyabe Health Project is a consortium of seven federally recognized tribes and two Native American communities that run from Death Valley north into Mono County to Colleville.
Earlier this week, Toiyabe CEO Kori Novak said an internal investigation and a third-party audit into the pharmacy revealed incidents of fraud, including some pharmacists writing prescriptions to themselves, a lack of control over medications and the possibility that some patients might have gotten incorrect prescriptions dispensed to them. The third-party audit summary included a number of irregularities, including robot drug cells mislabeled available to use in the medication-dispensing robot, expired controlled drugs from 2015 found in safe towards the bottom in a bin, drugs in computer inventory not found in pharmacy and loose tablets behind the counting machine at designated prescription filling stations.
“We are now coming forward to tell the city of Bishop and the Native American tribes of Toiyabe that they have been lied to by this CEO,” the letter, from pharmacists Fred DiRisio, Gary DiRisio, Jeff Tatum, and Natalie Chang, and pharmacy technicians Rick Behrendt and Celia White, states. “There has been an ongoing series of disagreements between the pharmacy and the administration. The pharmacy staff has attempted to rectify these issues. However, the administration has been unwilling to let us speak or to allow us to utilize our rights to due process.”
Regarding the allegation of issuing fraudulent prescriptions, the pharmacy staff members point out that since 1991, there have been policies and procedures that are required by the pharmacy to process prescriptions. This includes prescription faxes, verbal orders, direct verbal communications with a provider, and authorizations by the nurses acting as agents of the providers. These polices, according to the pharmacy staff, comply with the California State Board of Pharmacy and Toiyabe’s Policy. The pharmacy staff has always followed these procedures as mandated by state law and Toiyabe clinic.
“Furthermore, there have been numerous audits over the years by Indian Health Services (IHS) and none of these audits have discovered any illegal or fraudulent activity in the pharmacy,” the letter states. “The pharmacy has been constantly commended for its compliance to policies and procedures. As the pharmacy staff, we take these policies very seriously.”
Due to waste, damage, and expiration of products, pharmacies are allowed an acceptable percentage of loss and the pharmacy staff has constantly maintained less than 3 percent of total loss according to annual inventory reports.
“Any mistakes that have been made in the last 20 years, while infrequent, have been documented and corrected,” the pharmacy staff states.
The pharmacy staff maintains that it has discovered numerous violations of the Health Insurance Portability and Accountability Act by the Toiyabe administration. HIPAA, which provides data privacy and security provisions for safeguarding medical information, contains a Treatment, Payment and Operations clause (TPO) in which the actions of providers, methods of payment, and actions of administrations are detailed. While the TPO allows the clinic’s administration to access patients’ records to conduct quality assessment and conduct auditing services, the pharmacy staff alleges the Toiyabe administration has accessed records using fraudulent “tags” in the computer system as a way to cover its tracks. Specific “tags” allow access to patient files for specific reasons, such as the chief financial officer can access the CFO file or “tag” for a designated purpose. According to the pharmacy staff, however, “various members” of the administration used the “Pharmacist” tag and viewed patients’ files using that tag. The staff states it has computer screen shots of administrators improperly using tags and accessing patient records, which compromised the patients’ personal medical information.
“In other words, this administration has posed as ‘Pharmacists’ and ‘Pharmacy Technicians’ to access private patient information,” according to the pharmacy staff. “This is a serious offense and as pharmacists, we are required by HIPAA to notify you, the Native Community. We have asked the administration to cooperate with the pharmacy in complying with HIPAA and they have not cooperated in any way whatsoever … This left the pharmacy no choice, but to contact (Indian Health Services) IHS to explain this egregious and highly illegal act … As of now, there are hundreds of Native American patients having their prescription and medical files being accessed through the administration’s nefarious methods.”
The staff states that the administration conducted an internal investigation regarding the alleged HIPAA violations, which is tantamount to the administration investigating its and a conflict of interest.
The staff states that Novak as well as other members of the administration have access to the pharmacy without a pharmacist present. According to its letter, two members of the administration accessed the pharmacy on a Sunday after the audit was completed.
“How can we be sure they were not the ones mismanaging medications or funds by having unbridled access to the pharmacy?” the letter posits.
The letter, six pages in total, states that the clinic’s administrators still have access to all private patient information on their computers.
“This administration’s acts of corruption have caused great damage to this clinic and they have violated the Native community’s trust as the various protests from tribal members have demonstrated,” the letter states. “The administration’s actions have also deeply hurt us emotionally and mentally. We have felt like we were treated like criminals. Never have we seen an administration so vindictive and so determined to permanently damage our reputations. To have them exploit the Native community in this manner is disturbing and just another example of the horrible mistreatment Native Americans have experienced for far too long … People of the Native American community, stand up for your right to receive proper medical care and to be treated with respect. Stand up and tell this incompetent administration, ‘Enough is enough.’”

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