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Clinical Pharmacy Medical Expert Witness


Expert Witness No.1423

New York

Education and Training

1976, Doctor of Pharmacy, College of Pharmaceutical Sciences, university in New York

1975, ASHP-Accredited Residency (2 YEARS), Clinical/Administrative Program, medical center in New York

1973, Bachelor of Science In Pharmacy

1972, Bachelor of Science In Health Sciences, College of Pharmaceutical Sciences, university in New York

Professional Appointments

2002, Director of Pharmacy, medical center in New York

1990, Clinical Coordinator, Pharmacy Director, Pharmacy Practice & Geriatric Specialty Residency Programs, medical center, New York

1988, Clinical Coordinator - Anesthesiology/O.R., 1986, Director, Education And Training, 1985, Director, Drug Information/Audit, 1984, Staff Pharmacist, medical center in New York

1980, Director Of Pharmacy, medical & mental health center in New York

1976, Manager, Clinical Pharmacy Services, medical center in New York

1975, Staff Pharmacist, medical center in New York

1973, House Staff Resident (Pharmacy), Clinical Teaching Assistant (Columbia University) medical center in New York

Present, Drug Regimen Review Pharmacist-Per Diem, Home & Hospital in New York

Present, Medico-Legal Consultant/CEO for a pharmacotherapy firm

Present, Geriatric Pharmacist Consultant-Drug Regimen Review for a consulting service

1998-2000, PBM Pharmacy Consultant for a pharmacy service

1984-1992, Per Diem Pharmacist at a pharmacy, New York

1989 & 1990, Clinical Assistant Professor of Pharmacy, 1980, Adjunct Assistant Clinical Professor of Pharmacy, 1978, Assistant Clinical Professor of Pharmacy, 1976, Adjunct Clinical Professor of Pharmacy at a college of pharmacy in New York

1977-1980, Consultant Pharmacist, Skilled Nursing Facilities

Awards

Syntex Preceptor Of The Year, A & M Schwartz College of Pharmacy and Health Sciences

College Award, College of Pharmaceutical Sciences, Columbia University

Pharmacy License

New York State

Board Certifications

Pharmacotherapy Specialist
Certified Geriatric Pharmacist
Bcps (Board Certified Pharmacotherapy Specialist)
Cgp (Certified Geriatric Pharmacist)
Pharmacy License: New York State

Experience

Present, Consultant Pharmacist-Drug Regimen Review (Drr). 
Monthly review of medical records for approximately 1,500 long-term/extended care and rehabilitation residents.  Submit recommendations to physicians regarding:  Potential drug-drug interactions, potential drug-disease state interactions, apparent or potential drug side effects, duplication of drug therapy, possible changes to increase drug therapy compliance, opportunities to taper or discontinue drug therapy.

2002-2003, Director Of Pharmacy, medical center in New York.
Responsible for overall direction (operational, financial, legal, clinical) of Pharmacy.  Services in this 180-bed acute care community teaching hospital affiliated with New York Medical College until closing in 2003. Daily operational oversight for: Unit Dose Distribution, IV Preparations (IV Additives, Chemotherapy, TPN), Controlled Substances issues to ER, or Suite, Intensive Care, Med/Surg, OB/Gyn, Pediatrics, Chemical Dependency Unit.  Re-established control of Pharmacy expenditures.  Redesigned pharmacy storage areas for more efficient storage.  Established Pharmacy Charge Master in cooperation with IS and Finance for capture of Ambulatory Chemotherapy and Inpatient Pass-through Medication reimbursement.  Involved with, Pharmacy & Therapeutics Committee, Infection Control Committee, Quality Assurance Committee, and Safety Committee

Responsible for converting to WMC Formulary, Pharmacy Policy & Procedures, procurement process and Pharmacy A2K computer system.  Responsible for site-implementation of WMC clinical pharmacy and financial initiatives.  Responsible for re-registering with state (Board of Pharmacy, State Liquor Authority Bureau of Controlled Substances) and federal (DEA, ATF) licensing agencies, Member of Pharmacy & Therapeutics Committee.

1990-2002, Clinical Pharmacy Coordinator Director, Pharmacy Practice Residency Program, medical center in New York. 
Responsible for coordinating and supervising the clinical activities of clinical pharmacy specialists (Ambulatory Care, Primary Care, Acute Care, MUE/ADR, Infectious Diseases, Oncology, Psychiatry, Renal/Dialysis, Nutrition Support), pharmacy practice residents, clinical staff pharmacists, College of Pharmacy faculty and students (5th year & PharmD) assigned to this facility: 410 beds (290 acute, 120 long term care), >240,000 outpatient visits/>300,000 Rx annually (Primary Care, ER, >70 Subspecialty Clinics). Computerized Physician Order Entry, PYXIS, ATC-212, OptiFill.

Responsible for coordinating pharmacy research and investigational drug distribution (>60 active protocols + clozapine distribution) and accountability as well as supervision of the Investigational Drug Service Pharmacy Specialist and Research Pharmacist, developed and implemented fee structure for non-VA funded drug protocols, designed and implemented Responsibility/Task Statements for inpatient protocols, developed and implemented protocol prescribing/dispensing instruction sheets for protocol prescribers and staff pharmacists, assisted investigators in protocol design, blinding and randomization, principal investigator for funded EPO (Epoetin) Utilization Review Program.

Responsible for the coordination, dissemination (Pharmacy Bulletin) and provision of drug information, proficient in use of drug information databases: IOWA, Medline, IPA, ASHP Drug Information Fulltext, Drug Interaction Facts on Disk, Drug Facts & Comparisons on CDROM, USP DI Plus, MicroMedex, clinical references/texts/periodicals procured on my review and recommendation.  Responsible for the coordination and review of drug use and drug therapy (DUE/MUE, ADR’s, Albumin Usage Review.)

Responsible for coordination of the Pharmacy Service educational process for patients, health care professionals and students.  Responsible for the development of training opportunities to improve clinical skills of the pharmacy staff (>36 hours CE/year, ASHP Clinical Skills Modules, audio-visuals)  Coordinator/Instructor for ASHP Clinical Skills Pharmaceutical Care Program.  Responsible for the preparation and revision of the medical center formulary, maintenance of mainframe computer on-line drug database, hard copy desktop PC publication (reformatted downloaded database)

Responsible for working cooperatively with the medical, dental, nursing and research staffs to explore, organize and implement interdisciplinary programs which will enhance education, training and clinical involvement

Appointed to the following committees/teams:  Pharmacy & Therapeutics Committee, Research & Development Committee, Human Studies (IRB) Subcommittee, Learning Resources Committee, Critical Care Committee & CPR Subcommittee, Clozapine Treatment Team

Independent VA provider authorized through Scope of Practice to perform the following advanced pharmaceutical care functions:  Documentation of assessments and activities in the Medical Record, Order inpatient drug therapies and associated lab/diagnostic tests, Order consultations from relevant clinical services, Assess adverse drug reactions, Authorize use of restricted formulary/non-formulary drug, Conduct clinical research, Prescribe 90-day supply of medication (exception: Controlled Substances), Provided oversight for pharmacist-managed Ticlopidine Monitoring Clinic to assure FDA-required monitoring for first 90 days of therapy

Pain Management Provider, consultant to Pain Management Service for complex chronic pain patients, participant, Spinal Cord Injury (SCI) Pain Management Group, participated in development and implementation of PCA program for acute pain.

Preparation and delivery of 2+ hour presentation on newly approved drugs for annual pharmacology update for nursing service. Assist in determining other pertinent topics and recommending other qualified pharmacotherapy speakers

Planned and implemented 14-16 week schedules, supervised and graded 5th year pharmacy students for 3 semesters until recruitment of replacement on-site faculty

Preceptor/site-liaison University of Minnesota College of Pharmacy B.S. Clinical Clerkship, Implemented ASHP-accredited Pharmacy Practice Residency.  Funding proposal approved by VA Central Office for one resident, first resident candidate recruited, funding proposal approved for additional two residents (total 3), successful recruitment of 3 resident candidates, ASHP survey conducted resulted in accreditation awarded, successful recruitment of 3 resident candidates.  Developed residency manual, evaluation forms, site-specific goals & objectives, reformatted ASHP goals & objectives into Goal Certification forms.  Participated in annual Eastern States conference for Pharmacy Residents & Preceptors, residents’ poster and/or platform presentation: topic approval/preparation oversight, Presentation Moderator, Preceptor Town hall participation

Increased pharmaceutical care capability of pharmacy service through successful national recruitment (including ASHP Mid-Year Personnel Placement interviews) of a Primary Care Pharmacy Specialist, Internal Medicine Pharmacy Specialist

Continuing Education Hours achieved during appointment: 1990-24; 1991-35; 1992-39.4; 1993-60.5; 1994-51.5; 1995-62; 1996-188 (Completed sufficient PSAP CE for board recertification through 2007)

PC (Laptop/Pentium/fax-modem/scanner-Windows/WordPerfect/MS Office/SPSS) routinely used for preparation of reports, forms, correspondence, database.  System interfaced with MUMPS-based integrated hospital database (Pharmacy IP/OP, Laboratory, ADT, E-Mail, Progress Notes, BBS, Internet, CD-ROM databases)

Successful preparation for and participation in JCAHO surveys

Successful preparation for and achievement of ASHP accreditation (6 years) for Pharmacy Practice Residency Program (3 residents per year)

1988-1990, Clinical Coordinator - Anesthesiology/O.R., medical center in New York. 
Responsible for provision of clinical pharmacy services (drug information, drug utilization review, patient monitoring) to the Department of Anesthesiology, the Recovery Room, Operating Room, Surgical ICU and Cardio-Thoracic Surgery Intermediate Care Unit.  Responsible for the daily distribution and audit of peri-operative controlled substances to Anesthesiologists, Nurse Anesthetists and Pain Service Staff.  Determined initial drug inventory and supplies required for operation of newly opened Anesthesia/O.R. Pharmacy Satellite.  Performed cost analysis of drugs utilized by the Department of Anesthesiology to determine appropriate cost reduction measures.  Drug Utilization Review (DUR) audits performed/assisted:  Albumin Use in Coronary Artery Bypass Graft Surgery, Dobutamine Usage in Critical Care Units

Assured clinical experience opportunities for LIU pharmacy students during 3-day Surgery/Anesthesiology rotation.  Performed drug storage inspections on a monthly basis for the O.R., Recovery Room and Hemodialysis.  IBM PC/XT routinely used to prepare all reports, forms and correspondence.  Provided weekend supervisory coverage of Pharmacy Department services as required

1986-1988, Director Of Education And Training, medical center, New York. 
Directed 6-month technician training program sponsored by a Training & Upgrading Fund. Responsibilities included: development and scheduling of training modules, lecture preparation and presentation (210 hours), development and implementation of assessment methods & documentation.  Successfully trained and placed 19 program graduates.  Responsible for orientation of newly hired pharmacists, pharmacy externs, pharmacy technicians.  Responsible for determining continuing education needs of pharmacist and pharmacy technician staffs. Scheduled timely and pertinent Inservice/CE programs on a monthly basis.  IBM PC/XT routinely used to prepare reports, schedules, training/orientation guidelines, procedures, correspondence.  Provided drug information services back-up as required.  Provided weekend supervisory coverage of Pharmacy Department services as required

1985-1986, Director Of Drug Information/Audit, medical center, in New York. 
Provided drug information for 800 bed teaching hospital and affiliates (Approximately 15-20 calls daily.)  Prepared Drug Information Reviews to assist the Pharmacy & Therapeutics Committee in the consideration of proposed additions to the formulary.  Edited quarterly MMC newsletter, providing professional staffs with drug/therapeutics reviews, updates to the formulary, etc.  Edited monthly newsletter highlighting information on drug therapy and drug preparation/administration for Nursing and Pharmacy staffs.  Published quarterly supplements to the formulary. Prepared agenda and minutes for Pharmacy and Therapeutics Committee meetings. Participated in Adverse Drug Reaction Subcommittee meetings. Responsible for developing and performing Drug Utilization Reviews (DUR). Results reported to P & T Committee and published in newsletter.  DUR audits performed: Human Albumin Usage, Cimetidine Use in Stress Ulcers, Cefoxitin Use by Surgical Service.  IBM PC/XT used to prepare reports, correspondence and publications.

1984-1985, Staff Pharmacist, medical center in New York

1984, Per Diem Pharmacist

1980-1984, Director Of Pharmacy, medical & mental health center in New York. 
Responsible for overall direction of Pharmacy Services in this 550 bed acute care teaching institution. Comprehensive pharmacy service provided from four pharmacy sites (staff of 44.) Record of no pharmacy deficiencies or recommendations in two consecutive JCAH accreditation surveys.  Assisted in RFP preparation for Pharmacy computer system vendors for NYC Health & Hospitals Corporation (NYCHHC.) Pharmacy consultant to Project Director. Designed and implemented Emergency Room Pharmacy Satellite. Implemented redesign of Outpatient Pharmacy waiting area to allow semi-private counseling and decreased waiting time. Implemented physical reorganization of Inpatient Unit Dose to allow more efficient operation. Designed and implemented Comprehensive Doctor’s Order Sheet for hospital-wide use, eliminating the use of two forms. Increased Pharmacy educational activities by 60%. Instituted monthly pharmacology/therapeutics lecture series for Department of OB/GYN to assist in complying with C.R.E.O.G. Resident Training Guidelines. Redesigned and re-equipped Sterile Preparations Room to allow more efficient and faster preparation of sterile products. Implemented Quality Assurance Program for microbiological monitoring and preventive maintenance of the Laminar Air Flow Hood.

Refined Pharmacy data collection and processing system for antibiotic dispensing allowing on-going review of usage by the Medical Staff (received commendation by JCAH surveyor.) Due to drug information background, was able to procure for the LMMHC Pharmacy a designation as one of the Satellite Drug Information Centers of the International Pharmaceutic and Therapeutic Drug Information Center of the College of Pharmacy & Health Sciences. Upgraded and expanded Pharmacy Library and implemented medical literature monitoring system with assistance of Medical Library. Medical references reviewer for Medical Library. Justified acquisition of IBM Displaywriter word processing system for development of semi-automated purchase order generation system and formulary maintenance system. Secretary-Pharmacy and Therapeutics Committee, prepared agenda, minutes, drug information reviews, Chairperson-Subcommittee on Nutrition, Member-Infection Control Committee, Member-Safety Committee

1976-1980, Manager, Clinical Pharmacy Services, medical center, New York.
Clinical resource person for Pharmacy Department. Drug Information resource person for Medical Center. Provided continuing education and inservice programs for Pharmacy staff. Appointed by Medical Board to serve on: Subcommittee on Hyperalimentation (TPN,) Committee on Diet & Nutrition, Pharmacy & Therapeutics Committee. Developed monitoring system to assist in problem-oriented review of patient therapy via the pharmacy medication profile. Developed and directed an integrated clinical externship program for approximately 40 fifth-year pharmacy students per year. Developed and directed a clinical externship program for approximately 65 fourth-year pharmacy students per year. Provided regularly scheduled pharmacology and therapeutics lectures for Nursing Refresher Course (BIMC Nursing School Program.) Provided biannual lecture for Critical Care Nurses on Drug Absorption & Distribution. Performed daily monitoring on all patients receiving Parenteral Nutrition. Prepared drug information reviews for agents proposed for formulary addition. Continually upgraded Pharmacy drug information resources. Consultant to Medical Library on new pharmacotherapy texts/periodicals. Developed comprehensive periodical monitoring system with Medical Library assistance. Evaluated adverse drug reaction reports. Participated in monthly nursing unit inspections. Supervised Pharmacy staff assigned to Sterile Preparations Area. Developed procedures: formulation, preparation and quality control (sterile, non-sterile.) Instructed Pharmacy staff and students in aseptic technique and laminar flow technology used in preparation of sterile products.

1975-1976, Staff Pharmacist, medical center in New York. Reorganized floor stock/I.V. delivery schedule. Updated procedure for Pharmacy Department participation in external disasters. Rotated through all service areas of Pharmacy Department (UD, TPN, OPD)

1973-1975, House Staff Resident (Pharmacy), medical center in New York,
Clinical Teaching Assistant, College of Pharmaceutical Sciences at a university in New York. Rotated through Clinical Departments of Medicine, Surgery, Pediatric & Adolescent Medicine, Psychiatry. Drug Information Service Assistant. Assisted in preparing drug evaluations on agents proposed for admission to formulary. Researcher for Adverse Drug Reaction Subcommittee. Member, Drug Utilization Review Committee for hospital (MMC Affiliate.)

Assistant lecturer in Pharmacology for the following MMC Training Programs: O.R. Nurses, O.R. Technicians, X-Ray Technicians. Responsible for scheduling, supervising, lecturing and grading fifth-year pharmacy students assigned to MMC clinical externship. Supervised Unit Dose dispensing area and Quality Control Service during Administrative Rotation. Assisted in expansion of Unit Dose dispensing system, including orientation of Pharmacy and Nursing staffs on evenings & nights. Developed and implemented major reorganization of Unit Dose picking stations in the Pharmacy. Developed and implemented prescribing form which standardized the dosage and quantity for non-prescription drugs. Assisted in the development and implementation of patient profile forms, Physician order forms and procedures for their use. Devised and performed I.V. fluid utilization study which resulted in change of floor stock par levels and easier delivery. Designed and performed study (Doctoral Project) on Psychotropic Drug Knowledge Of Prescribers (therapy, pharmacokinetics, toxicology). Performed jointly with Department of Psychiatry.

1977-1980, Consultant Pharmacist, Skilled Nursing Facilities,
Evaluated appropriateness of drug therapy. Monitored for possible occurrences of adverse drug reactions, drug toxicity. Reviewed nursing records for required accuracy and completeness. Reviewed pharmacy vendor for accuracy.

1989-1990, Clinical Assistant Professor of Pharmacy,
Preceptor for PHP 503/504 Externship/Clinical Clerkship. Consultant – Doctor of Pharmacy (PharmD) program development

1980-1984, Adjunct Assistant Clinical Professor of Pharmacy, college of pharmacy and health sciences. Graduate Division Instructor for 15 week required course for M.S. program: STERILE PRODUCTS IN HOSPITAL PHARMACY. Undergraduate Division Guest Instructor in Hospital Pharmacy Administration

1976-1978, Assistant and Adjunct Clinical Professor of Pharmacy, college of pharmacy and health sciences. Developed and implemented syllabi for clinical externship programs for fourth and fifth year pharmacy students assigned to Medical Center. Member-Subcommittee on Grading; Admissions Committee. Provided disease state and drug therapy lectures to fourth and fifth year classes - COPD, Neurology, Cardiology, Rheumatology. Lecturer for Continuing Education Series, Current Therapy Of Venereal Diseases.

1970-1973, Laboratory Assistant (Work Study,) Pharmacy Analysis Laboratory, College of Pharmaceutical Sciences, university in New York.

Associations

Academy of Managed Care Pharmacy (AMCP)
American Society of Consultant Pharmacists (ASCP)
American Society of Health-System Pharmacists (ASHP)
American College of Clinical Pharmacy (ACCP)
American Pharmacists Association (APhA)
New York State Chapter - American College of Clinical Pharmacy (NYS - ACCP)
New York State Council of Health-System Pharmacists (NYSCHP)
New York City Society of Health-System Pharmacists (NYCSHP)
Westchester/Rockland Society of Health-System Pharmacists (WRSHP)

Publications

Available upon request

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